Impact of electric cardioversion on platelet activation

Introduction Atrial fibrillation (AF) comes along with high risk of stroke. This risk continues even after re-establishing sinus rhythm with cardioversion. Aim of this study is to evaluate the contribution of electric cardioversion (EC) to platelet activation and procoagulatory tendency. Methods Extent of platelet activation before and after electric cardioversion was quantified using flow cytometry, impedance aggregation measurements with Multiplate®, and quantification of serum levels of platelet factor 4 (PF4) and ß-thromboglobulin (ß-TG) in patients with AF (N = 10). Results No significant differences were observed in any of the measured parameters comparing the values from before and after cardioversion. Geometric means of P-selectin expression and integrin αIIbβ3 activation were 0.27 (+/- 0.07) and 2.30 (+/- 2.61) before EC and 0.28 (+/- 0.17) and 1.67 (+/- 1.82) after EC. Levels of ß-TG were 110.11 ng/ml (+/- 3.78) before and 110.51 ng/ml (+/- 2.56) after EC, levels of PF4 were 35.64 ng/ml (+/- 12.94) before and 32.40 ng/ml (+/- 4.95) after EC. Platelet aggregation triggered with adenosine diphosphate (ADP), arachidonic acid, collagen, Ristocetin, or thrombin receptor activating peptide (TRAP) revealed results within the normally expected ranges without significant changes before and after EC. Discussion Electric cardioversion has no influence on platelet activation markers which is in agreement with other studies reporting electrical cardioversion to be safe.

Nearly fatal hypokalaemia due to non-hypertensive primary hyperaldosteronism in the post partum

A previously healthy postpartum 33-year-old woman was admitted at the emergency department after two episodes of syncope. In the waiting room, she collapsed, ventricular fibrillation was detected, and she was reanimated by electric cardioversion. At admission, she was conscient, with blood pressure of 102/74 mm Hg and heart rate of 78 bpm. In the laboratory workup, severe hypokalaemia was found (K+ 1.77 mEq/L). Abdominopelvic CT revealed a 27 mm nodule in the right adrenal gland. High aldosterone and low plasma renin levels were detected, and the diagnosis of primary hyperaldosteronism was made, although she never had hypertension. Posteriorly, a cosecretion of aldosterone and cortisol was found. Two months after admission, the patient remained stable with normal K+ levels under spironolactone and a right adrenalectomy was performed. The cure of primary hyperaldosteronism and a partial adrenal insufficiency were confirmed. K+ levels and blood pressure remained normal without treatment and 10 months after surgery hydrocortisone was suspended.

Timing and degree of left atrial stunning and reverse functional remodeling following electrical cardioversion in patients with recent onset atrial fibrillation

Background Atrial fibrillation (AF) results in left atrial electrical, structural and functional remodeling. Restoration of sinus rhythm hallmarks the beginning of reverse remodeling, the extent of which may depend on the type of AF. Purpose The aim of the study was to assess resumption of left atrial function after electric cardioversion in patients with recent onset AF and to explore the association between reverse remodeling and the type of atrial fibrillation. Methods Patients with AF duration <48 hours were prospectively included. Trans-thoracic echocardiography was performed prior, immediately after (2–4 hours) and 7–10 days following CV. Left atrial volume index (LAVI), left atrial global longitudinal strain during reservoir (LAGLS-res), conduit (LAGLS-cond) and contractile (LAGLS-contr) phases, left atrial ejection fraction (LAEF) and left ventricular ejection fraction (LVEF) were measured. Results Forty-three patients (84% males) aged 55±9.6 years, (mean±SD), with median CHA2DS2-VASc score 1 (interquartile range 0–1) were included. Repeated measure analysis of variance revealed a statistically significant overall change for LAGLS-res F(2,78)=55.4, p<0,001, LAGLS-cond F(2,78)=23.3, p<0,001, LAGLS-contr F(2,78)=39.7, p<0,001, LAEF F(2,80)=28.5, p<0.001 and LVEF F(2,80)=8.4, p<0.001. At 7–10 days, LAGLS-contr 12±4%, LAEF 53±9% and LVEF 60±6 (mean±SD) return within normal reference intervals. Notably left atrial recovery seems to precede left ventricular recovery. No statistical significant interaction with the type of atrial fibrillation could be shown. Conclusion Left atrial functional reverse remodeling occurs within ten days after successful electric cardioversion of patients with recent onset atrial fibrillation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung Foundation, Correvio International Sárl (Geneva Switzerland), Selanders Stiftelse

Frequency and nature of complications associated with drug and electric cardioversion in patients with atrial fibrillation in hypertension in combination with extracardial comorbid pathology and adherence to treatment

Aim. To evaluate the complex of antiarrhythmic therapy and adherence to treatment on an outpatient basis in patients with atrial fibrillation in hypertension in combination with extracardiac diseases.Methods. In an observational cohort study, 308 men aged 45–60 years old were observed with atrial fibrillation and hypertension in combination with diabetes mellitus (n = 40), diffuse toxic goiter (n = 42), hypothyroidism (n = 59), abdominal obesity (n = 64) and chronic obstructive pulmonary disease (n = 47). The comparison group consisted of 56 patients without extracardiac pathology. The work evaluated clinical, anthropometric data, the results of daily monitoring of ECG and echocardiography. Adherence to therapy was evaluated using a specialized Moriski-Green questionnaire.Results. Patients with diabetes mellitus on the background of electric cardioversion significantly more often developed CHF (p = 0.003), cardioembolism (p < 0.001), hospitalization (p = 0.040) and progression of AF (p < 0.050), relative to the comparison group. The number of regospitalizations was noted less after electrical cardioversion compared with only medical one. The adherence to drug therapy in patients with atrial fibrillation in hypertension with extracardiac disease was 26.7 %.Conclusion. The reasons for the lack of patient adherence to treatment require an integrated approach to its early resolution.

CASE OF ACQUIRED COAGULOPATHY

In recent years, the number of patients receiving anticoagulant therapy worldwide is growing rapidly. This is due to the rapidly expanding scope of their application: an increasing number of patients with non-valvular heart disease, including atrial fibrillation, the risk of thromboembolic events, an increase in the number of surgical interventions, especially in cardiac surgery (in the treatment of valvular heart disease, cardiac anomalies, infective endocarditis, staging of heart pacemakers, conducting electric cardioversion), the use of anticoagulants in the treatment of other organs and systems (in neurology, angiosurgery, obstetrics and gynecology). Despite the presence of a large number of anticoagulants in the arsenal of the modern physician, one of the most studied and often prescribed is varfarin. Warfarin is an anticoagulant of the indirect action of the coumarin group, a competitive antagonist of vitamin K. However, along with high availability and efficiency of its use, it has a large number of possible contraindications and features of the reception, such as: many drug-drug and other interactions, the need for careful control of the dosage and the regimen of the drug, strict control of the international normalized ratio throughout therapy. With caution, this drug should be used in patients who abuse alcohol and have cognitive impairment. In this group of patients, in addition to personal awareness of patients, it is necessary to conduct explanatory conversations with relatives / caregivers about all possible side effects and measures for their prevention. Non-observance of precautionary measures at therapy by warfarin can lead to heavy, and in rare instances even lethal consequences, one of which is warfarin-induced coagulopathy. This clinical case presents a case of the development of severe acquired (warfarin-induced) coagulopathy in a patient with cognitive dysfunction.