The role of inflammation in the pathogenesis and treatment of arrhythmias

The pathogenesis of arrhythmias is complex and multifactorial. The role of inflammation in the pathogenesis of both atrial and ventricular arrhythmias (VA) has been explored. However, developing successful pharmacotherapy regimens based on those pathways has proven more of a challenge. This narrative review provides an overview of five common arrhythmias impacted by inflammation, including atrial fibrillation (AF), myocardial infarction, arrhythmogenic cardiomyopathy, cardiac sarcoidosis, and QT prolongation, and the potential role for anti-inflammatory therapy in their management. We identified arrhythmias and arrhythmogenic disease states with the most evidence linking pathogenesis to inflammation and conducted comprehensive searches of United States National Library of Medicine MEDLINE^® and PubMed databases. Although a variety of agents have been studied for the management of AF, primarily in an effort to reduce postoperative AF following cardiac surgery, no standard anti-inflammatory agents are used in clinical practice at this time. Although inflammation following myocardial infarction may contribute to the development of VA, there is no clear benefit with the use of anti-inflammatory agents at this time. Similarly, although inflammation is clearly linked to the development of arrhythmias in arrhythmogenic cardiomyopathy, data demonstrating a benefit with anti-inflammatory agents are limited. Cardiac sarcoidosis, an infiltrative disease eliciting an immune response, is primarily treated by immunosuppressive therapy and steroids, despite a lack of primary literature to support such regimens. In this case, anti-inflammatory agents are frequently used in clinical practice. The pathophysiology of arrhythmias is complex, and inflammation likely plays a role in both onset and duration, however, for most arrhythmias the role of pharmacotherapy targeting inflammation remains unclear.     

The quadricuspid truncal valve: Surgical management and outcomes

ObjectiveTo determine the outcomes of patients with a quadricuspid truncal valve (TV) and durability of TV repair.MethodWe reviewed 56 patients with truncus arteriosus and a quadricuspid TV who underwent complete repair between 1979 and 2018.ResultsTV insufficiency was present in 39 patients (mild, n = 22; moderate, n = 14; and severe, n = 3). Fourteen patients had concomitant TV surgery. Early mortality in patients who had concomitant TV surgery was 14% (2 out of 14 patients) and overall survival was 77.1% ± 11.7% at 15 years. Freedom from TV reoperation was 30.3% ± 14.6% at 15 years. Early mortality in patients who did not undergo concomitant TV surgery was 9.5% (4 out of 42 patients) and overall survival was 74.9% ± 6.9% at 15 years. Progression of TV insufficiency requiring TV surgery occurred in 16.7% (7 out of 42 patients). Freedom from TV reoperation was 77.1% ± 7.8% at 15 years. The most common method of repair was tricuspidization of the TV. Freedom from TV reoperation was 64.3% ± 21.0% at 10 years after tricuspidization and 0% at 6 years after other types of TV surgery. Overall follow-up was 97.6% (41 out of 42 patients) complete for survivors with median follow-up of 16.6 years. At last follow-up there was no TV insufficiency in 16 patients, mild insufficiency in 24 patients, and moderate insufficiency in 1 patient.ConclusionsMore than one-third of patients with a quadricuspid TV require TV surgery. Tricuspidization of the quadricuspid TV appears to be a durable repair option with good long-term outcomes.     

Assessing efficacy of day 3 embryo time-lapse algorithms retrospectively: impacts of dataset type and confounding factors

This study investigated the efficacy of four published day 3 embryo time-lapse algorithms based on different types of datasets (known implantation data [KID] and single embryo transfer [SET]), and the confounding effect of female age and conventional embryo morphology. Four algorithms were retrospectively applied to three types of datasets generated at Fertility North between February 2013 and December 2014: (a) KID dataset (n?=?270), (b) a subset of SET (n?=?144, end-point?=?implantation), and (c) SET (n?=?144, end-point?=?live birth), respectively. All four algorithms showed progressively reduced predictive power (expressed as area under the receiver operating characteristics curve and 95% confidence interval [CI]) after application to the three datasets (a–c): Liu (0.762 [0.701–0.824] vs. 0.724 [0.641–0.807] vs. 0.707 [0.620–0.793]), KIDScore (0.614 [0.539–0.688] vs. 0.548 [0.451–0.645] vs. 0.536 [0.434–0.637]), Meseguer (0.585 [0.508–0.663] vs. 0.56 [0.462–0.658] vs. 0.549 [0.445–0.652]), and Basile (0.582 [0.505–0.659] vs. 0.519 [0.421–0.618] vs. 0.509 [0.406–0.612]). Furthermore, using KID dataset, the association (expressed as odds ratio and 95% CI) between time-lapse algorithms and implantation outcomes lost statistical significance after adjusting for conventional embryo morphology and female age in 3 of the 4 algorithms (KIDScore 1.832 [1.118–3.004] vs. 1.063 [0.659–1.715], Meseguer 1.150 [1.021–1.295] vs. 1.122 [0.981–1.284] and Basile 1.122 [1.008–1.249] vs. 1.038 [0.919–1.172]). In conclusion, SET is a preferred dataset to KID when developing or validating time-lapse algorithms, and day 3 conventional embryo morphology and female age should be considered as confounding factors.     

Readability of Online Information on Celiac Disease: A Brief Report

Abstract

Celiac disease (CD) is an autoimmune condition characterized by an intolerance to dietary gluten for those with a genetic predisposition. The Internet has become a key source of information about CD as well as a gluten-free diet (GFD), although the quality is varied. There has been little investigation into the readability of online CD information. Keyword “celiac disease” was used for a search in the browser, Google Chrome. URLs of the first 100 English websites were recorded; sponsored or advertised websites were not included in the sample. Five recommended tests generated by Readable.io were utilized to assess the sample’s readability scores. Only one of the 100 websites received an acceptable reading score on two of the five reading assessments. Websites with extensions of .com or .org were equally likely to be written at the same unacceptable level. Informational websites on celiac disease may serve as an unintentional barrier for consumers seeking readable, online material on this health topic.     

The Orthostatic Discriminant and Severity Scale (ODSS): an assessment of orthostatic intolerance

Clinical Autonomic Research - To assess the ability of the Orthostatic Discriminant and Severity Scale (ODSS) to distinguish symptoms of orthostatic intolerance from non-orthostatic symptoms....     

Response to: Human papillomavirus (HPV) vaccine safety concerning POTS,CRPS and related conditions

Clinical Autonomic Research -     

Autonomic dysfunction and phenoconversion in idiopathic REM sleep behavior disorder

Clinical Autonomic Research - REM sleep behavior disorder (RBD) is a common finding among patients with synucleinopathies. We aimed to determine the degree of autonomic dysfunction in patients...