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      Tips for management of arrhythmias in endocrine disorders from an European Heart Rhythm Association position paper

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          Abstract

          In endocrine diseases, hormonal changes, electrolyte abnormalities, and the deterioration of heart structure can lead to various arrhythmias. In diabetic patients, hypoglycemia, hyperglycemia, and hypokalemia can trigger arrhythmias, and diabetic cardiomyopathy can also cause electrical and structural remodeling to form substrates for arrhythmias. The risk of atrial fibrillation (AF) increases in hyperthyroidism; however, the prevalence of ventricular arrhythmias in hypothyroidism is higher. Besides AF and ventricular tachycardias, bradycardias and atrioventricular blocks can also be seen in pheochromocytoma due to the desensitization of adrenergic cardiovascular receptors. The correction of metabolic and electrolyte disturbances in patients with adrenal cortex disease should be the main approach in the prevention and treatment of arrhythmias. Early initiation of treatment in patients with acromegaly seems to decrease the development of cardiac remodeling and ventricular arrhythmia. Early and late after depolarizations due to hypercalcemia in hyperparathyroidism can lead to life-threatening ventricular arrhythmias. This elegant position paper provides important recommendations regarding prevention and treatment of arrhythmias for specific endocrine disorders.

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          Acromegaly: an endocrine society clinical practice guideline.

          Laurence Katznelson, Edward Laws, Shlomo Melmed … (2014)
          The aim was to formulate clinical practice guidelines for acromegaly.
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            Does hypoglycaemia increase the risk of cardiovascular events? A report from the ORIGIN trial.

            Rafael Díaz-Sobac, Linda G. Mellbin, … (2013)
            Hypoglycaemia caused by glucose-lowering therapy has been linked to cardiovascular (CV) events. The ORIGIN trial provides an opportunity to further assess this relationship. A total of 12 537 participants with dysglycaemia and high CV-risk were randomized to basal insulin glargine titrated to a fasting glucose of ≤ 5.3 mmol/L (95 mg/dL) or standard glycaemic care. Non-severe hypoglycaemia was defined as symptoms confirmed by glucose ≤ 54 mg/dL and severe hypoglycaemia as a requirement for assistance or glucose ≤ 36 mg/dL. Outcomes were: (i) the composite of CV death, non-fatal myocardial infarction or stroke; (ii) mortality; (iii) CV mortality; and (iv) arrhythmic death. Hazards were estimated before and after adjustment for a hypoglycaemia propensity score. During a median of 6.2 years (IQR: 5.8-6.7), non-severe hypoglycaemic episodes occurred in 41.7 and 14.4% glargine and standard group participants, respectively, while severe episodes occurred in 5.7 and 1.8%, respectively. Non-severe hypoglycaemia was not associated with any outcome following adjustment. Conversely, severe hypoglycaemia was associated with a greater risk for the primary outcome (HR: 1.58; 95% CI: 1.24-2.02, P < 0.001), mortality (HR: 1.74; 95% CI: 1.39-2.19, P < 0.001), CV death (HR: 1.71; 95% CI: 1.27-2.30, P < 0.001) and arrhythmic death (HR: 1.77; 95% CI: 1.17-2.67, P = 0.007). Similar findings were noted for severe nocturnal hypoglycaemia for the primary outcome and mortality. The severe hypoglycaemia hazard for all four outcomes was higher with standard care than with insulin glargine. Severe hypoglycaemia is associated with an increased risk for CV outcomes in people at high CV risk and dysglycaemia. Although allocation to insulin glargine vs. standard care was associated with an increased risk of severe and non-severe hypoglycaemia, the relative risk of CV outcomes with hypoglycaemia was lower with insulin glargine-based glucose-lowering therapy than with the standard glycaemic control. Trial Registration (ORIGIN ClinicalTrials.gov number NCT00069784).
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              Impact of intensive glycemic control on the incidence of atrial fibrillation and associated cardiovascular outcomes in patients with type 2 diabetes mellitus (from the Action to Control Cardiovascular Risk in Diabetes Study).

              Omid Fatemi, Eugene Yuriditsky, Costas Tsioufis … (2014)
              Atrial fibrillation (AF) is prevalent in patients with type 2 diabetes mellitus (DM) and is associated with markers of poor glycemic control; however, the impact of glycemic control on incident AF and outcomes is unknown. The aims of this study were to prospectively evaluate if intensive glycemic control in patients with DM affects incident AF and to evaluate morbidity and mortality in patients with DM and incident AF. A total of 10,082 patients with DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohort were studied in a randomized, double-blind fashion. Participants were randomized to an intensive therapeutic strategy targeting a glycated hemoglobin level of <6.0% or a standard strategy targeting a glycated hemoglobin level of 7.0% to 7.9%. Incident AF occurred in 159 patients (1.58%) over the follow-up period, at a rate of 5.9 per 1,000 patient-years in the intensive-therapy group and a rate of 6.37 per 1,000 patient-years in the standard-therapy group (p = 0.52). In a multivariate model, predictors of incident AF were age, weight, diastolic blood pressure, heart rate, and heart failure history. Patients with DM and new-onset AF had a hazard ratio of 2.65 for all-cause mortality (95% confidence interval 1.8 to 3.86, p <0.0001), a hazard ratio of 2.1 for myocardial infarction (95% confidence interval 1.33 to 3.31, p = 0.0015), and a hazard ratio of 3.80 for the development of heart failure (95% confidence interval 2.48 to 5.84, p <0.0001). In conclusion, intensive glycemic control did not affect the rate of new-onset AF. Patients with DM and incident AF had an increased risk for morbidity and mortality compared with those without AF.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Anatol J Cardiol
                Journal ID (iso-abbrev): Anatol J Cardiol
                Title: Anatolian Journal of Cardiology
                Publisher: Kare Publishing (Turkey )
                ISSN (Print): 2149-2263
                ISSN (Electronic): 2149-2271
                Publication date (Print): October 2018
                Volume: 20
                Issue: 4
                Pages: 241-245
                Affiliations
                [1]Department of Cardiology, Faculty of Medicine, Dokuz Eylül University; İzmir- Turkey
                [1 ]Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University; Eskişehir- Turkey
                Author notes
                Address for correspondence: Dr. Bülent Görenek, Eskişehir Osmangazi Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Meşelik Kampüsü, Eskişehir- Türkiye Phone: +90 222 229 22 66 E-mail: bulent@ 123456gorenek.com
                Article
                Publisher ID: AJC-20-241
                DOI: 10.14744/AnatolJCardiol.2018.87260
                PMC ID: 6249537
                PubMed ID: 30297583
                SO-VID: b471122f-766a-4776-ae50-589b1595349b
                Copyright © Copyright: © 2018 Turkish Society of Cardiology
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

                History
                Date accepted : 03 August 2018
                Categories
                Subject: Invited Review

                Keywords: endocrine disorders,arrhythmias,diabetes mellitus,thyroid dysfunction
                Data availability:
                Keywords: endocrine disorders, arrhythmias, diabetes mellitus, thyroid dysfunction

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