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Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment

World Journal of Diabetes 2023年第5期14卷 512-527页

作者： Marianna Leopoulou Panagiotis Theofilis athanasios kordalis Nikolaos Papageorgiou Marios Sagris Evangelos Oikonomou Dimitris Tousoulis 1^(st)Cardiology Clinic ‘Hippokration’General HospitalNational and Kapodistrian University of AthensSchool of MedicineAthens 11527Greece 3^(rd)Cardiology Clinic ‘Sotiria’Chest Diseases HospitalNational and Kapodistrian University of AthensSchool of MedicineAthens 11527Greece

Type 2 diabetes mellitus(T2DM)is a leading risk factor for cardiovascular complications around the globe and one of the most common medical *** fibrillation(AF)is the most common supraventricular arrhythmia,with a rapidly increasing prevalence.T2DM has been closely associated with the risk of AF development,identified as an independent risk *** cardiovascular complications,both AF and T2DM have been linked with high *** underlying pathophysiology has not been fully determined yet;however,it is multifactorial,including structural,electrical,and autonomic *** therapies include pharmaceutical agents in sodium-glucose cotransporter-2 inhibitors,as well as antiarrhythmic strategies,such as cardioversion and *** interest,glucose-lowering therapies may affect the prevalence of *** review presents the current evidence regarding the connection between the two entities,the pathophysiological pathways that link them,and the therapeutic options that exist.

关键词： Atrial fibrillation Diabetes mellitus Pathophysiology Treatment

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Arrhythmic risk stratification in ischemic,non-ischemic and hypertrophic cardiomyopathy:A two-step multifactorial,electrophysiology study inclusive approach

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World Journal of Cardiology 2022年第3期14卷 139-151页

作者： Petros Arsenos Konstantinos A Gatzoulis Dimitrios Tsiachris Polychronis Dilaveris Skevos Sideris Ilias Sotiropoulos Stefanos Archontakis Christos-Konstantinos Antoniou athanasios kordalis Ioannis Skiadas Konstantinos Toutouzas Charalambos Vlachopoulos Dimitrios Tousoulis Konstantinos Tsioufis First Department of Cardiology National and Kapodistrian University of AthensHippokration HospitalAthens 11527AttikaGreece Athens Heart Center Athens Medical CenterAthens 15125AttikaGreece Department of Cardiology Hippokration HospitalAthens 11527AttikaGreece Fifth Department of Cardiology Hygeia HospitalMarousi 15123AttikaGreece

Annual arrhythmic sudden cardiac death ranges from 0.6%to 4%in ischemic cardiomyopathy(ICM),1%to 2%in non-ischemic cardiomyopathy(NICM),and 1%in hypertrophic cardiomyopathy(HCM).Towards a more effective arrhythmic risk stratification(ARS)we hereby present a two-step ARS with the usage of seven non-invasive risk factors:Late potentials presence(≥2/3 positive criteria),premature ventricular contractions(≥30/h),non-sustained ventricular tachycardia(≥1episode/24 h),abnormal heart rate turbulence(onset≥0%and slope≤2.5 ms)and reduced deceleration capacity(≤4.5 ms),abnormal T wave alternans(≥65μV),decreased heart rate variability(SDNN440 ms in males and>450 ms in females)which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first *** the second step,these intermediate-risk patients undergo a programmed ventricular stimulation(PVS)for the detection of inducible,truly high-risk ICM and NICM patients,who will benefit from an implantable cardioverter *** HCM patients,we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter.

关键词： Arrhythmic sudden cardiac death Risk stratification Non-invasive risk factors Electrophysiology study Two-step approach Arrhythmias in cardiomyopathy

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Exercise Intolerance and Excessive Chronotropic Response Due to Possible Autonomic Dysfunction Post COVID-19 Infection

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International Journal of Clinical Medicine 2023年第12期14卷 540-551页

作者： Stefanos Archontakis Dimitrios Venetsanos Nikias Milaras Eirini Beneki Panagiotis Dourvas Epameinondas Triantafyllou Konstantinos Sideris Konstantina Aggeli Petros Arsenos athanasios kordalis Konstantinos Gatzoulis Skevos Sideris Department of Cardiology Hippokration General Hospital Athens Greece First Cardiology Division Hippokration General Hospital Medical School University of Athens Athens Greece

Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.

关键词： COVID-19 Autonomic Neuropathy Exertional Intolerance Exaggerated Chronotropic Response POTS Dysautonomia

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多电极经导管去肾交感神经射频消融术对难治性高血压伴心肌肥厚患者的心脏及神经体液功能适应性的影响

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中华高血压杂志 2014年第11期22卷 1003-1003页

作者：刘莉叶鹏 Tsioufis C Papademetriou V Dimitriadis K Tsiachris D Thomopoulos C Kasiakogias A kordalis A Kefala A Koutra E Lau EO Grassi G Stefanadis C

该研究旨在通过EnligHTNⅠ研究中的非随机亚组分析探讨多电极经导管去肾交感神经射频消融术（renal denervation,RDN）对难治性高血压患者心脏及神经体液功能适应性的影响。方法：入选确诊为难治性高血压伴左心室肥厚,行多电极RDN患者1... 详细信息

该研究旨在通过EnligHTNⅠ研究中的非随机亚组分析探讨多电极经导管去肾交感神经射频消融术（renal denervation,RDN）对难治性高血压患者心脏及神经体液功能适应性的影响。方法：入选确诊为难治性高血压伴左心室肥厚,行多电极RDN患者18例为研究对象[年龄（56±10）岁,12例为男性,体质量指数为（33.6±5.4）kg/m2,诊室电子血压计测量的血压为（182±19）/（97±18）mm Hg,1mm Hg=0.133kPa,

关键词：难治性高血压高血压患者功能适应性射频消融术肾交感神经神经体液多电极心肌肥厚

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