Lead extraction is a challenging procedure and needs to be performed by more centers throughout Brazil. The reasons for the underuse of the procedure and the necessary actions needed to be taken by the medical community are discussed in the text.
{"title":"What Stops Us from Performing More Pacemaker Electrodes Extractions?","authors":"Rodrigo Minati Barbosa","doi":"10.24207/jca.v36i1.3487","DOIUrl":"https://doi.org/10.24207/jca.v36i1.3487","url":null,"abstract":"Lead extraction is a challenging procedure and needs to be performed by more centers throughout Brazil. The reasons for the underuse of the procedure and the necessary actions needed to be taken by the medical community are discussed in the text.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"170 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134922888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patrícia Demuner, D. Freitas, F. Oliveira, S. R. Alessi, M. Prudente, F. Fernandes, F. Barbosa, E. Guimarães, R. C. D. O. E. Silva, Guiulliano Gardenghi
Introduction: Data on the impact of left bundle-branch block after transcatheter aortic valve implantation (TAVI) are scarce, and treatment has been individualized. Based on this, the electrophysiological study (EPS) concomitant with TAVI may be a strategy for the early stratification of patients needing permanent pacemaker implantation (PPM). Objective: To describe the use of EPS in risk stratification of a definitive pacemaker in patients undergoing TAVI. Materials and methods: Data from seven patients with indications for TAVI due to critical aortic stenosis were retrospectively evaluated. The EPS was performed with a quadripolar diagnostic catheter in His bundle to measure the His-ventricle (HV) interval. Measurement of HV at 70 ms or above was used for discussion on PPM implant indication. Results: Four analyzed patients evolved with left bundle-branch block after TAVI. PPM implantation was indicated for one patient, and the surgery was performed uneventfully during the same hospital stay. Before TAVI, the HV interval ranged from 46 to 58 ms (mean = 53.2 ms), increasing to 52 to 84 ms (mean = 62.8 ms) immediately after valve intervention. Conclusion: The strategy of EPS during TAVI is viable to stratify patients early according to the risk of 2nd or 3rd-degree atrioventricular block, allowing adequate treatment.
{"title":"Concomitant Electrophysiological Study with Transcatheter Aortic Valve Implantation to Predict Risk of Atrioventricular Block","authors":"Patrícia Demuner, D. Freitas, F. Oliveira, S. R. Alessi, M. Prudente, F. Fernandes, F. Barbosa, E. Guimarães, R. C. D. O. E. Silva, Guiulliano Gardenghi","doi":"10.24207/jca.v36i1.3483","DOIUrl":"https://doi.org/10.24207/jca.v36i1.3483","url":null,"abstract":"Introduction: Data on the impact of left bundle-branch block after transcatheter aortic valve implantation (TAVI) are scarce, and treatment has been individualized. Based on this, the electrophysiological study (EPS) concomitant with TAVI may be a strategy for the early stratification of patients needing permanent pacemaker implantation (PPM). Objective: To describe the use of EPS in risk stratification of a definitive pacemaker in patients undergoing TAVI. Materials and methods: Data from seven patients with indications for TAVI due to critical aortic stenosis were retrospectively evaluated. The EPS was performed with a quadripolar diagnostic catheter in His bundle to measure the His-ventricle (HV) interval. Measurement of HV at 70 ms or above was used for discussion on PPM implant indication. Results: Four analyzed patients evolved with left bundle-branch block after TAVI. PPM implantation was indicated for one patient, and the surgery was performed uneventfully during the same hospital stay. Before TAVI, the HV interval ranged from 46 to 58 ms (mean = 53.2 ms), increasing to 52 to 84 ms (mean = 62.8 ms) immediately after valve intervention. Conclusion: The strategy of EPS during TAVI is viable to stratify patients early according to the risk of 2nd or 3rd-degree atrioventricular block, allowing adequate treatment.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41349689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wide access to information and images on the internet and social networks has been considered an important source of research and understanding of the most varied clinical pathologies. As a result, the term “doctor Google” was coined to draw attention to the growing interest of the general population in this alternative source of research. The aim of this case report was to emphasize that physicians should be aware of the fact that complementary exams available on the internet can be a confounding factor and a source of information or images that can interfere with the diagnostic analysis and potentially with the clinical management of patients.
{"title":"Google’s Ventricular Tachycardia","authors":"Jorge Elias Neto, Márcio Augusto Silva","doi":"10.24207/jca.v36i1.3476","DOIUrl":"https://doi.org/10.24207/jca.v36i1.3476","url":null,"abstract":"Wide access to information and images on the internet and social networks has been considered an important source of research and understanding of the most varied clinical pathologies. As a result, the term “doctor Google” was coined to draw attention to the growing interest of the general population in this alternative source of research. The aim of this case report was to emphasize that physicians should be aware of the fact that complementary exams available on the internet can be a confounding factor and a source of information or images that can interfere with the diagnostic analysis and potentially with the clinical management of patients.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46693576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Long QT syndrome is a disease associated with a high risk of sudden cardiac (arrhythmic) death. The frequency of sudden cardiac death is approximately 1: 100,000 young athletes, while autopsies often do not detect changes, which indicates a primary arrhythmogenic death. The article describes two clinical cases of young athletes with prolongation of the QT interval. The possible causes of the long QT syndrome and the difficulties of diagnosing this syndrome in children and adolescents involved in sports are discussed. Regardless of the reasons leading to the prolongation of the QT interval, there is a risk of arrhythmic events. Timely diagnosis of long QT syndrome is the way to the primary prevention of sudden cardiac death in young athletes.
{"title":"Long QT Syndrome in Young Athletes","authors":"S. Chuprova, I. Melnikova","doi":"10.17816/cardar321415","DOIUrl":"https://doi.org/10.17816/cardar321415","url":null,"abstract":"Long QT syndrome is a disease associated with a high risk of sudden cardiac (arrhythmic) death. The frequency of sudden cardiac death is approximately 1: 100,000 young athletes, while autopsies often do not detect changes, which indicates a primary arrhythmogenic death. The article describes two clinical cases of young athletes with prolongation of the QT interval. The possible causes of the long QT syndrome and the difficulties of diagnosing this syndrome in children and adolescents involved in sports are discussed. Regardless of the reasons leading to the prolongation of the QT interval, there is a risk of arrhythmic events. Timely diagnosis of long QT syndrome is the way to the primary prevention of sudden cardiac death in young athletes.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89933998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Snezhitskiy, A. Kopytsky, Tatyana L. Barysenkо (Kepurko)
BACKGROUND: In recent years, asymptomatic hyperuricemia (HU) has been found to have significant adverse effects on the cardiovascular system. Uric acid (UA) accumulation in cardiomyocytes may cause ionic and structural remodeling of the atria. One of the causes of increased UA and a significant risk factor for HU is polymorphism in the SLC2A9 gene, which encodes the GLUT9 protein, a highly specific urate transporter in proximal renal tubular cells. AIM: To investigate the frequency of genotypes and alleles of the SLC2A9 gene rs734553 polymorphism and left atrium (LA) diameter in patients with arterial hypertension (AHT) and atrial fibrillation (AF). MATERIALS AND METHODS: One hundred four patients, including 94 (90.4%) men and 10 (9.6%) women (aged 55 [45; 61] years old) were enrolled in the study. The patients were divided into the following groups: first patients with AF (n = 13); second patients with AHT and AF (n = 68); and third patients with AHT (n = 23). The LA diameter equal to the LA anteriorposterior dimension on transthoracic echocardiography was taken into account as a characteristic of structural changes of the LA. All patients underwent instrumental, laboratory, and molecular genetic testing, including SLC2A9 gene rs734553 polymorphism using the polymerase chain reaction technique. The data were presented as median, first and third quartiles, and absolute and relative frequencies. Differences between groups of patients were assessed using the Mann Whitney U-test and Fisher and Pearsons test. The KruskalWallis test was used to compare three independent groups. Differences were considered statistically significant at p 0.05. The relationship between the quantitative and dichotomous variables was described using the rank-biserial correlation coefficient (rrb). The distribution of alleles and genotypes in the studied patient groups was tested for Hardy Weinberg equilibrium and assessed using the 2 test. RESULTS: There were no significant differences (p 0.05) when comparing the LA diameter and the genotype of the SLC2A9 gene rs734553 polymorphism in all groups of patients. However, in Group 2, the LA diameter in the CC genotype (43 [42; 44] mm) patients and the AC genotype (40 [49; 43] mm) patients was determined to be larger than in the AA genotype ones (38 [38; 42] mm). In Group 1, the LA diameter in the AC genotype patients (40 [38; 42] mm) was larger than in the AA genotype ones (38 [34; 38] mm). When studying the distribution frequency of genotypes and alleles of the SLC2A9 gene rs734553 polymorphism in patients with LA dilatation, we found that in the second group of patients, the AC genotype was significantly more common than in other groups (23.5%) (p = 0.004), and there was also a trend toward a higher incidence of AA (13.2%) and CC (14.7%) genotypes. However, it did not reach the criteria for statistical significance. It should be noted that in patients of the first group, LA dilatation was diagnosed only with the AC genot
{"title":"SLC2A9 Genotype Distribution and Left Atrium Diameter in Patients with Arterial Hypertension and Atrial Fibrillation","authors":"V. Snezhitskiy, A. Kopytsky, Tatyana L. Barysenkо (Kepurko)","doi":"10.17816/cardar164429","DOIUrl":"https://doi.org/10.17816/cardar164429","url":null,"abstract":"BACKGROUND: In recent years, asymptomatic hyperuricemia (HU) has been found to have significant adverse effects on the cardiovascular system. Uric acid (UA) accumulation in cardiomyocytes may cause ionic and structural remodeling of the atria. One of the causes of increased UA and a significant risk factor for HU is polymorphism in the SLC2A9 gene, which encodes the GLUT9 protein, a highly specific urate transporter in proximal renal tubular cells. \u0000AIM: To investigate the frequency of genotypes and alleles of the SLC2A9 gene rs734553 polymorphism and left atrium (LA) diameter in patients with arterial hypertension (AHT) and atrial fibrillation (AF). \u0000MATERIALS AND METHODS: One hundred four patients, including 94 (90.4%) men and 10 (9.6%) women (aged 55 [45; 61] years old) were enrolled in the study. The patients were divided into the following groups: first patients with AF (n = 13); second patients with AHT and AF (n = 68); and third patients with AHT (n = 23). The LA diameter equal to the LA anteriorposterior dimension on transthoracic echocardiography was taken into account as a characteristic of structural changes of the LA. All patients underwent instrumental, laboratory, and molecular genetic testing, including SLC2A9 gene rs734553 polymorphism using the polymerase chain reaction technique. \u0000The data were presented as median, first and third quartiles, and absolute and relative frequencies. Differences between groups of patients were assessed using the Mann Whitney U-test and Fisher and Pearsons test. The KruskalWallis test was used to compare three independent groups. Differences were considered statistically significant at p 0.05. The relationship between the quantitative and dichotomous variables was described using the rank-biserial correlation coefficient (rrb). The distribution of alleles and genotypes in the studied patient groups was tested for Hardy Weinberg equilibrium and assessed using the 2 test. \u0000RESULTS: There were no significant differences (p 0.05) when comparing the LA diameter and the genotype of the SLC2A9 gene rs734553 polymorphism in all groups of patients. However, in Group 2, the LA diameter in the CC genotype (43 [42; 44] mm) patients and the AC genotype (40 [49; 43] mm) patients was determined to be larger than in the AA genotype ones (38 [38; 42] mm). In Group 1, the LA diameter in the AC genotype patients (40 [38; 42] mm) was larger than in the AA genotype ones (38 [34; 38] mm). \u0000When studying the distribution frequency of genotypes and alleles of the SLC2A9 gene rs734553 polymorphism in patients with LA dilatation, we found that in the second group of patients, the AC genotype was significantly more common than in other groups (23.5%) (p = 0.004), and there was also a trend toward a higher incidence of AA (13.2%) and CC (14.7%) genotypes. However, it did not reach the criteria for statistical significance. It should be noted that in patients of the first group, LA dilatation was diagnosed only with the AC genot","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88773607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Chmelevsky, M. Budanova, Danila A. Stepanov, E. Zhabina, T. É. Tulintseva
BACKGROUND: Differential diagnosis of arrhythmias with wide QRS complexes remains an unresolved problem in clinical practice. After decades of careful research, many different criteria and algorithms have been proposed, but many of them are not quite accurate and effective in real clinical conditions. One of the approaches is to use ECG to estimate the speed of propagation of excitation through the ventricular myocardium. The estimation is based on the ratio of the amplitudes of the initial and final parts of the QRS complex, in particular, using the slow conduction index. AIM: To study the possibility of using the slow conduction index in the differential diagnosis of arrhythmias with wide QRS complexes and to carry out a detailed comparative analysis of the diagnostic value of this criterion in all 12 ECG leads with evaluation and comparison of the obtained values of diagnostic accuracy. MATERIALS AND METHODS: The study included 280 single wide QRS complexes with a form of left bundle branch block (LBBB) detected during one-day and multi-day ECG monitoring in randomly selected 28 patients. For a detailed analysis, a comparison of the original 12-lead ECG and individual scalable ECG graphs for selected leads was carried out, followed by measurement of the absolute values of the total amplitudes during the initial and final 40 ms wide QRS complexes. For a qualitative and quantitative assessment of diagnostic significance, ROC analysis was used to determine the informative value of a diagnostic test based on sensitivity (Sn), specificity (Sp) and diagnostic accuracy (Acc). RESULTS: According to the obtained values of Sn, Sp and Acc, all 12 leads were arranged in the following order as the diagnostic value of the slow conduction index decreased: aVL, V2, aVF, V5, III, V1, V4, II, aVR, V6, V3 and I. In the first six ECG leads, Acc was consistently above 90%, gradually decreasing in the next six leads from 89% to 67%, respectively (p 0.001 for all leads). CONCLUSIONS: The results of this study showed that the slow conduction index can be used in any ECG leads as a criterion for the differential diagnosis of arrhythmias with wide QRS complexes with a form of LBBB. The study also demonstrated the importance of a comprehensive approach to the analysis of the form of the QRS complex and the need for a consistent detailed analysis of the existing criteria for the differential diagnosis of arrhythmias with wide QRS complexes in different clinical groups of patients.
{"title":"Diagnostic Value of Slow Conduction Index in Differential Diagnosis of Wide QRS Complex Arrhythmias with Left Bundle Branch Block Morphology","authors":"M. Chmelevsky, M. Budanova, Danila A. Stepanov, E. Zhabina, T. É. Tulintseva","doi":"10.17816/cardar233537","DOIUrl":"https://doi.org/10.17816/cardar233537","url":null,"abstract":"BACKGROUND: Differential diagnosis of arrhythmias with wide QRS complexes remains an unresolved problem in clinical practice. After decades of careful research, many different criteria and algorithms have been proposed, but many of them are not quite accurate and effective in real clinical conditions. One of the approaches is to use ECG to estimate the speed of propagation of excitation through the ventricular myocardium. The estimation is based on the ratio of the amplitudes of the initial and final parts of the QRS complex, in particular, using the slow conduction index. \u0000AIM: To study the possibility of using the slow conduction index in the differential diagnosis of arrhythmias with wide QRS complexes and to carry out a detailed comparative analysis of the diagnostic value of this criterion in all 12 ECG leads with evaluation and comparison of the obtained values of diagnostic accuracy. \u0000MATERIALS AND METHODS: The study included 280 single wide QRS complexes with a form of left bundle branch block (LBBB) detected during one-day and multi-day ECG monitoring in randomly selected 28 patients. For a detailed analysis, a comparison of the original 12-lead ECG and individual scalable ECG graphs for selected leads was carried out, followed by measurement of the absolute values of the total amplitudes during the initial and final 40 ms wide QRS complexes. For a qualitative and quantitative assessment of diagnostic significance, ROC analysis was used to determine the informative value of a diagnostic test based on sensitivity (Sn), specificity (Sp) and diagnostic accuracy (Acc). \u0000RESULTS: According to the obtained values of Sn, Sp and Acc, all 12 leads were arranged in the following order as the diagnostic value of the slow conduction index decreased: aVL, V2, aVF, V5, III, V1, V4, II, aVR, V6, V3 and I. In the first six ECG leads, Acc was consistently above 90%, gradually decreasing in the next six leads from 89% to 67%, respectively (p 0.001 for all leads). \u0000CONCLUSIONS: The results of this study showed that the slow conduction index can be used in any ECG leads as a criterion for the differential diagnosis of arrhythmias with wide QRS complexes with a form of LBBB. The study also demonstrated the importance of a comprehensive approach to the analysis of the form of the QRS complex and the need for a consistent detailed analysis of the existing criteria for the differential diagnosis of arrhythmias with wide QRS complexes in different clinical groups of patients.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75476488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Catheter ablation (CA) is an established method for atrial fibrillation (AF) treatment. Up to 20% of patients with AF develop coronary artery disease (CAD) as a secondary diagnosis. The data on whether the CAD affects the efficacy of AF ablation is contrary, while arterial hypertension is a known risk factor for AF as well as for AF recurrence after the CA. AIM: We conducted this research to assess the AF recurrence rate and its risk factors after the primary catheter AF ablation procedure in the different clinical groups including IdiopathicAF, AF concomitant to arterial hypertension (HTN) and AF concomitant to CAD. MATERIALS AND METHODS: Patients who underwent 451 PVI procedures performed since January 2016 to December 2017 were screened for AH, CAD and other structural heart disease. Among them 153 pts were selected for the subsequent analysis and divided into 3 groups IdiopathicAF, AF + AH, AF + CAD. RESULTS: The presence of CAD (r = 0.313, p 0.001), age (r = 0.224, p = 0.008), CHA2DS2-VASc score (r = 0.279, p = 0.001), history of MI (r = 0.240, p = 0.004), LA size (r = 0.204, p = 0.018) were correlated with the recurrence rate. In the AF + CAD group patients older than 65 years demonstrated dramatically lower AF-free survival rate (37.5%) in comparison to younger CAD population (75%, log-rank p 0.001) as well as to younger and older non-CAD patients. CONCLUSIONS: The presence of CAD should always attract the attention of physicians before considering the AF ablation as an option to treatment. Elderly CAD patients have the lowest ablation efficacy and the best strategy for this group (more extensive primary ablation or conversion to the permanent AF) needs to be studied.
背景:导管消融(CA)是治疗心房颤动(AF)的一种既定方法。高达20%的房颤患者继发诊断为冠状动脉疾病(CAD)。关于冠心病是否影响房颤消融疗效的数据是相反的，而动脉高压是房颤的已知危险因素，也是房颤术后复发的危险因素。目的:我们开展本研究，评估特发性房颤、房颤合并动脉高压(HTN)和房颤合并CAD等不同临床组房颤经导管消融后的房颤复发率及其危险因素。材料和方法:自2016年1月至2017年12月接受451例PVI手术的患者筛查AH, CAD和其他结构性心脏病。选取153例患者进行后续分析，分为特发性AF、AF + AH、AF + CAD 3组。结果:冠心病(r = 0.313, p 0.001)、年龄(r = 0.224, p = 0.008)、CHA2DS2-VASc评分(r = 0.279, p = 0.001)、心肌梗死史(r = 0.240, p = 0.004)、LA大小(r = 0.204, p = 0.018)与复发率相关。在AF + CAD组中，年龄大于65岁的患者的无AF生存率(37.5%)明显低于年轻CAD人群(75%，log-rank p 0.001)以及年轻和老年非CAD患者。结论:在考虑房颤消融作为治疗方案之前，CAD的存在应该引起医生的注意。老年冠心病患者的消融效果最低，对于这一群体的最佳策略(更广泛的原发性消融或转化为永久性房颤)需要研究。
{"title":"Atrial Fibrillation Recurrence Rate in Different Clinical Groups: Coronary Artery Disease and Age Matter","authors":"M. Gorev, I. Urazovskaya","doi":"10.17816/cardar305725","DOIUrl":"https://doi.org/10.17816/cardar305725","url":null,"abstract":"BACKGROUND: Catheter ablation (CA) is an established method for atrial fibrillation (AF) treatment. Up to 20% of patients with AF develop coronary artery disease (CAD) as a secondary diagnosis. The data on whether the CAD affects the efficacy of AF ablation is contrary, while arterial hypertension is a known risk factor for AF as well as for AF recurrence after the CA. \u0000AIM: We conducted this research to assess the AF recurrence rate and its risk factors after the primary catheter AF ablation procedure in the different clinical groups including IdiopathicAF, AF concomitant to arterial hypertension (HTN) and AF concomitant to CAD. \u0000MATERIALS AND METHODS: Patients who underwent 451 PVI procedures performed since January 2016 to December 2017 were screened for AH, CAD and other structural heart disease. Among them 153 pts were selected for the subsequent analysis and divided into 3 groups IdiopathicAF, AF + AH, AF + CAD. \u0000RESULTS: The presence of CAD (r = 0.313, p 0.001), age (r = 0.224, p = 0.008), CHA2DS2-VASc score (r = 0.279, p = 0.001), history of MI (r = 0.240, p = 0.004), LA size (r = 0.204, p = 0.018) were correlated with the recurrence rate. In the AF + CAD group patients older than 65 years demonstrated dramatically lower AF-free survival rate (37.5%) in comparison to younger CAD population (75%, log-rank p 0.001) as well as to younger and older non-CAD patients. \u0000CONCLUSIONS: The presence of CAD should always attract the attention of physicians before considering the AF ablation as an option to treatment. Elderly CAD patients have the lowest ablation efficacy and the best strategy for this group (more extensive primary ablation or conversion to the permanent AF) needs to be studied.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78504160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Numerous known risk factors for atrial fibrillation (AF) exist, but few studies have investigated the link between gastrointestinal and liver disorders. Through a variety of pathways, hepatic and gastrointestinal conditions can increase the risk of both prevalent and incident AF. According to numerous studies, liver dysfunction plays a significant role in the pathogenesis of atrial fibrillation. So, this review article aimed to give an overview of how liver function tests played role in the AF. Albumin, alkaline phosphatase, alanine transaminase, aspartate aminotransferase, gamma-glutamyl transferase, serum bilirubin, and prothrombin time were highlighted in the pathogenesis of AF. However, the 5’-nucleotidase test, alpha-fetoprotein test, mitochondrial antibodies test and more, and liver functions test need to find their pathogenesis in AF. The exact mechanism of action of the liver panel was not reported in the pathogenesis of AF. To control the major liver diseases in AF patients, the therapeutic management of liver function tests is required.
{"title":"Liver Function Tests in Atrial Fibrillation","authors":"Saira Rafaqat, Sana Rafaqat","doi":"10.24207/jca.v36i1.3478","DOIUrl":"https://doi.org/10.24207/jca.v36i1.3478","url":null,"abstract":"Numerous known risk factors for atrial fibrillation (AF) exist, but few studies have investigated the link between gastrointestinal and liver disorders. Through a variety of pathways, hepatic and gastrointestinal conditions can increase the risk of both prevalent and incident AF. According to numerous studies, liver dysfunction plays a significant role in the pathogenesis of atrial fibrillation. So, this review article aimed to give an overview of how liver function tests played role in the AF. Albumin, alkaline phosphatase, alanine transaminase, aspartate aminotransferase, gamma-glutamyl transferase, serum bilirubin, and prothrombin time were highlighted in the pathogenesis of AF. However, the 5’-nucleotidase test, alpha-fetoprotein test, mitochondrial antibodies test and more, and liver functions test need to find their pathogenesis in AF. The exact mechanism of action of the liver panel was not reported in the pathogenesis of AF. To control the major liver diseases in AF patients, the therapeutic management of liver function tests is required.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41902961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ventricular premature complexes originating from the tricuspid valve can be a major challenge for the electrophysiologist. Anatomical features of the tricuspid valve impose limitations for mapping and catheter ablation through the femoral vein (inferior approach). In this case, we report the elimination of a ventricular ectopy by radiofrequency catheter ablation through the transjugular approach after three unsuccessful attempts through the inferior approach.
{"title":"Transjugular Approach in Catheter Ablation of Ventricular Ectopy Originating from the Superior Tricuspid Annulus: An Effective Alternative to the Unsuccessful Transfemoral Approach","authors":"A. Cardoso","doi":"10.24207/jca.v36i1.3482","DOIUrl":"https://doi.org/10.24207/jca.v36i1.3482","url":null,"abstract":"Ventricular premature complexes originating from the tricuspid valve can be a major challenge for the electrophysiologist. Anatomical features of the tricuspid valve impose limitations for mapping and catheter ablation through the femoral vein (inferior approach). In this case, we report the elimination of a ventricular ectopy by radiofrequency catheter ablation through the transjugular approach after three unsuccessful attempts through the inferior approach.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47622532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zheming Wang, T. Makeeva, E. Zbyshevskaya, T. Butaev, Sergey A. Saiganov
ABSTRACT. Fatal ventricular arrhythmias in patients with diabetes mellitus (DM) in the acute stage of myocardial infarction (MI) and postinfarction period often cause adverse outcomes. Therefore, the search for new reliable biomarkers in predicting ventricular arrhythmias in the long term is necessary. AIM: This study aimed to evaluate the value of N-terminal-pro hormone BNP (NT-proBNP) in predicting ventricular arrhythmias in young and middle-aged patients with MI and DM-associated ST-segment elevation. MATERIALS AND METHODS: Seventy-six patients (59 men and 17 women) with DM and MI with ST-segment elevation (aged 3659 years; mean 53 5 years) were examined. Anterior MI was diagnosed in 35 patients, and non-anterior MI was detected in 41 patients. The DM duration was up to 1 year in 16 patients, 15 years in 24, and 512 years in 36. Patients were examined on day 1 after percutaneous coronary intervention (PCI) with implantation of 13 stents in the coronary arteries (CA) and again after 12 months. Holter monitoring, echocardiography, and blood tests for NT-proBNP were performed. RESULTS: After PCI, ventricular extrasystole (VES) of grades IIIV according to Lown and Wolf was detected in 21 of 37 (56.7%) patients with DM. The left ventricular ejection fraction (LVEF) was 42% (27%45%), and the NT-proBNP level was 1127 (7902530) at a rate of up to 125 pg/mL. After 12 months, VES was noted in 9 of 37 (24.3%) patients. The LVEF was 33% (28%35%), and the NT-proBNP level was 938 (4971294) pg/mL. A positive correlation was found between the blood serum level of NT-proBNP on day 1 after PCI and the number of grade IIIV VES 12 months later. At an NT-proBNP level of 898 pg/mL on day 1 after PCI, the sensitivity of this biomarker in predicting high-grade VES 12 months after MI in patients with DM was 100%. CONCLUSIONS: The NT-proBNP level after PCI in patients with DM and MI is a reliable predictor of ventricular arrhythmias over the next 12 months.
{"title":"Significance of the N-terminal Fragment of Brain Natriuretic Peptides in Predicting Ventricular Arrhythmias in Young and Middle-Aged Patients with Diabetes and Myocardial Infarction","authors":"Zheming Wang, T. Makeeva, E. Zbyshevskaya, T. Butaev, Sergey A. Saiganov","doi":"10.17816/cardar115243","DOIUrl":"https://doi.org/10.17816/cardar115243","url":null,"abstract":"ABSTRACT. Fatal ventricular arrhythmias in patients with diabetes mellitus (DM) in the acute stage of myocardial infarction (MI) and postinfarction period often cause adverse outcomes. Therefore, the search for new reliable biomarkers in predicting ventricular arrhythmias in the long term is necessary. \u0000AIM: This study aimed to evaluate the value of N-terminal-pro hormone BNP (NT-proBNP) in predicting ventricular arrhythmias in young and middle-aged patients with MI and DM-associated ST-segment elevation. \u0000MATERIALS AND METHODS: Seventy-six patients (59 men and 17 women) with DM and MI with ST-segment elevation (aged 3659 years; mean 53 5 years) were examined. Anterior MI was diagnosed in 35 patients, and non-anterior MI was detected in 41 patients. The DM duration was up to 1 year in 16 patients, 15 years in 24, and 512 years in 36. Patients were examined on day 1 after percutaneous coronary intervention (PCI) with implantation of 13 stents in the coronary arteries (CA) and again after 12 months. Holter monitoring, echocardiography, and blood tests for NT-proBNP were performed. \u0000RESULTS: After PCI, ventricular extrasystole (VES) of grades IIIV according to Lown and Wolf was detected in 21 of 37 (56.7%) patients with DM. The left ventricular ejection fraction (LVEF) was 42% (27%45%), and the NT-proBNP level was 1127 (7902530) at a rate of up to 125 pg/mL. After 12 months, VES was noted in 9 of 37 (24.3%) patients. The LVEF was 33% (28%35%), and the NT-proBNP level was 938 (4971294) pg/mL. A positive correlation was found between the blood serum level of NT-proBNP on day 1 after PCI and the number of grade IIIV VES 12 months later. At an NT-proBNP level of 898 pg/mL on day 1 after PCI, the sensitivity of this biomarker in predicting high-grade VES 12 months after MI in patients with DM was 100%. \u0000CONCLUSIONS: The NT-proBNP level after PCI in patients with DM and MI is a reliable predictor of ventricular arrhythmias over the next 12 months.","PeriodicalId":33934,"journal":{"name":"Journal of Cardiac Arrhythmias","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87728207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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