Prevalence and impact on outcome of electrocardiographic early repolarization patterns among stroke patients: a prospective observational study

Bobinger, Tobias; Kallmünzer, Bernd; Kopp, Markus; Kurka, Natalia; Arnold, Martin; Hilz, M. J.; Huttner, Hagen B.; Schwab, Stefan; Köhrmann, Martin

doi:10.1007/s00392-015-0831-6

Cited by 15 publications

(6 citation statements)

References 41 publications

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“…As in earlier studies, this cohort also confirmed an extension of the QT period as a predictor of mortality in the 3-month course [27]. However, the early repolarization pattern, which has received much attention over the last 10 years, may be of secondary importance for stroke patients [28].…”

Section: Tachycardic Arrhythmiassupporting

confidence: 87%

Cardiac Arrhythmia following Stroke

Kallmünzer

Schwab

2017

Neurology International Open

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The autonomous innervation of the heart is based on a complex interaction of central and peripheral mechanisms in sympathetic and parasympathetic parts of the autonomic nervous system (▶Fig. 1). An extrinsic cardiac innervation is distinguished from an intrinsic one. Extrinsic systemTo put it simply, a center of the efferent parasympathetic innervation of the heart is found in the nucleus of the medulla oblongata, especially in the nucleus dorsalis [1]. The preganglionic fibers leave the central nervous system along with the vagus nerve and are connected to the second neuron in cardiac ganglion cells. Sympath etic fibers, on the other hand, originate from the nucleus intermediolateralis of the upper thoracic cord [2]. They reach the plexus cardiacus by means of the so-called "cardiac nerves" (usually 4 right-sided and 3 left-sided nervi cardiaci), after interposition in the border ganglia, especially in the ganglion stellatum. For the control of cardiac functions, the profound part of the plexus cardiacus is decisive; it extends between the tracheal bifurcation and the aortic arch, divides into a right and left half and in its further course follows the right or left coronary artery. The function of the efferent limb is modified by afferents from various organ systems, including the gastrointestinal tract or the carotissinus, by means of multisynaptic reflex arcs (e. g., baroreflex) [1]. In addition, in the blood circulating catecholamine, the release of which in the adrenal system is also subject to the autonomic system, mediates beta-adrenergic effects on the myocardium. It is postulated that dysbalances in the extrinsic system, in particular the pathological disinhibition of sympathetic activity, are relevant to the development of cardiac arrhythmias [1,[3][4][5]. For example, extensive brain stem damage can lead to suppression of central parasympathetic functions and overcoming of sympathetic tone [6], thus promoting the occurrence of cardiac arrhythmias. Conversely, blockade of the ganglion stellatum or renal sympathetic denervation should reduce the risk of ventricular arrhythmias in patients with prolonged-QT syndromes [7]. It is noteworthy in this context that extensive cardiac denervation, which may be present after orthotopic heart transplantation, is associated with a lower risk of supra ventricular rhythm disturbances, especially atrial fibrillation [8]. In these cases, the denervation should have protective effects and protect the myocardium from the autonomic imbalances of the extrinsic system before transmission. It should be noted, however, that organ donors are usually much younger and the vascular damage to the donor organs is often less pronounced, which significantly reduces the risk of atrial fibrillation independent of cardiac denervation [9].

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Section: Tachycardic Arrhythmiassupporting

confidence: 87%

Cardiac Arrhythmia following Stroke

Kallmünzer

Schwab

2017

Neurology International Open

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“…The obvious advantages of this system are described as a minimization of lead complications as well as systemic infections. The system is especially attractive for patients with congenital heart disease [1], other rare entities impeding transvenous lead implantation [2,3] or electrical heart disease [4,5]. The early results of the worldwide EFFORTLESS-registry demonstrated an appropriate system performance.…”

Section: Sirsmentioning

confidence: 97%

Limitations in S-ICD therapy: reasons for system explantation

et al. 2015

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“…The obvious advantages of this system are marketed as a minimization of lead complications and systemic infections. This innovative system can particularly be considered in patients with congenital heart disease, other rare entities impeding transvenous lead implantation, or electrical heart disease . The early results of the worldwide Evaluation oF FactORs ImpacTing CLinical Outcome and Cost EffectiveneSS (EFFORTLESS) registry suggested an appropriate system performance.…”

Section: Introductionmentioning

confidence: 99%

“…This innovative system can particularly be considered in patients with congenital heart disease, 3 other rare entities impeding transvenous lead implantation, 4 or electrical heart disease. 5,6 The early results of the worldwide Evaluation oF FactORs ImpacTing CLinical Outcome and Cost Effective-neSS (EFFORTLESS) registry suggested an appropriate system performance. Occurrence of arrhythmic events and inappropriate shocks resembled those reported for conventional transvenous ICD systems.…”

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confidence: 99%

Intraoperative Defibrillation Testing of Subcutaneous Implantable Cardioverter‐Defibrillator Systems—A Simple Issue?

Frommeyer

Zumhagen

Dechering

et al. 2016

JAHA

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BackgroundThe results of the recently published randomized SIMPLE trial question the role of routine intraoperative defibrillation testing. However, testing is still recommended during implantation of the entirely subcutaneous implantable cardioverter‐defibrillator (S‐ICD) system. To address the question of whether defibrillation testing in S‐ICD systems is still necessary, we analyzed the data of a large, standard‐of‐care prospective single‐center S‐ICD registry.Methods and ResultsIn the present study, 102 consecutive patients received an S‐ICD for primary (n=50) or secondary prevention (n=52). Defibrillation testing was performed in all except 4 patients. In 74 (75%; 95% CI 0.66–0.83) of 98 patients, ventricular fibrillation was effectively terminated by the first programmed internal shock. In 24 (25%; 95% CI 0.22–0.44) of 98 patients, the first internal shock was ineffective and further internal or external shock deliveries were required. In these patients, programming to reversed shock polarity (n=14) or repositioning of the sensing lead (n=1) or the pulse generator (n=5) led to successful defibrillation. In 4 patients, a safety margin of <10 J was not attained. Nevertheless, in these 4 patients, ventricular arrhythmias were effectively terminated with an internal 80‐J shock.ConclusionsAlthough it has been shown that defibrillation testing is not necessary in transvenous ICD systems, it seems particular important for S‐ICD systems, because in nearly 25% of the cases the primary intraoperative test was not successful. In most cases, a successful defibrillation could be achieved by changing shock polarity or by optimizing the shock vector caused by the pulse generator or lead repositioning.

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Prevalence and impact on outcome of electrocardiographic early repolarization patterns among stroke patients: a prospective observational study

Abstract: ER is frequently found among patients with acute cerebrovascular events and is more prevalent in patients with hemorrhagic compared to ischemic events. Our study yields no evidence that ER is associated with worse outcome or mortality after stroke.

Cited by 15 publications

References 41 publications

Cardiac Arrhythmia following Stroke

Cardiac Arrhythmia following Stroke

Limitations in S-ICD therapy: reasons for system explantation

Intraoperative Defibrillation Testing of Subcutaneous Implantable Cardioverter‐Defibrillator Systems—A Simple Issue?

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