What is the mechanism of this post ablation atrial flutter "recurrence"?

We present the case of a patient with typical atrial flutter treated with radiofrequency ablation of the cavo-tricuspid isthmus, which presented 5 days later with an ECG suggesting an atrial flutter recurrence. However, careful analysis of this ECG demonstrated a potentially different mechanism of the arrhythmia, underlying the importance of a pragmatic approach to ECG interpretation of arrhythmias. A secondary electrophysiological study was performed diagnosing a focal atrial tachycardia with origin at the coronary sinus ostium, in the presence of a blocked cavotricuspid isthmus. RF ablation successfully suppressed the arrhythmia.

Relationship Between Ventricular Arrhythmias, Conduction Disorders, and Myocardial Fibrosis in Patients With Systemic Sclerosis.

BACKGROUND: Delayed-enhancement magnetic resonance imaging (DE-MRI) is a noninvasive diagnostic tool able to identify myocardial fibrosis. In patients with scleroderma, its relationship with arrhythmias and conduction disorders has not been fully explored. OBJECTIVES: The aim of this study was to evaluate the possible correlations between ventricular arrhythmias, conduction disorders, and myocardial fibrosis in patients with systemic sclerosis. METHODS: Thirty-six patients with diffuse or limited cutaneous scleroderma underwent 12-lead electrocardiogram (ECG), 24-hour Holter ECG monitoring, transthoracic echocardiography, and cardiac DE-MRI, with gadolinium administration in 33 patients. RESULTS: High-quality DE-MRI scans were obtained in 30 patients. Myocardial fibrosis was detected in 25 patients (83.3%). Eighteen patients (60%) had ventricular arrhythmias or conduction disorders. There was no significant difference in ventricular arrhythmia burden (the total number of premature ventricular contractions [PVCs]/24 hours) (48 ± 304 vs. 69 ± 236, P = 0.97), ventricular arrhythmia severity (couplets, triplets, runs) on Holter ECG, or in the presence of conduction disorders (36% vs. 40%, P = 0.86) between patients with and without myocardial fibrosis. In univariate analysis, diffuse fibrosis was weakly associated with the number of PVCs/24 hours (R = 0.157, P = 0.03). A number of at least 597 PVCs/24 hours had a sensitivity of 60% and a specificity of 92% in predicting the presence of diffuse fibrosis on DE-MRI (area under the curve = 0.640). CONCLUSIONS: Delayed-enhancement magnetic resonance imaging can identify myocardial fibrosis in a high percentage of scleroderma patients. Its presence does not seem to influence the ventricular arrhythmia burden and severity or the presence of conduction disorders, with the exception of diffuse myocardial fibrosis, which modestly influences the total number of PVCs/24 hours.

Recovery of Ventriculo-Atrial Conduction after Adrenaline in Patients Implanted with Pacemakers.

BACKGROUND: Ventriculo-atrial (VA) conduction can have negative consequences for patients with implanted pacemakers and defibrillators. There is concern whether impaired VA conduction could recover during stressful situations. Although the influence of isoproterenol and atropine are well established, the effect of adrenaline has not been studied systematically. The objective of this study was to determine if adrenaline can facilitate recovery of VA conduction in patients implanted with pacemakers. METHODS: A prospective study was conducted on 61 consecutive patients during a 4-month period (April-July 2014). The presence of VA conduction was assessed during the pacemaker implantation procedure. In case of an impaired VA conduction, adrenaline infusio was used as a stress surrogate to test conduction recovery. RESULTS: The indications for pacemaker implantation were: sinus node dysfunction in 18 patients, atrioventricular (AV) block in 40 patients, binodal dysfunction (sinus node+ AV node) in two patients and other (carotid sinus syndrome) in one patient. In the basal state, 15/61 (24.6%) presented spontaneous VA conduction and 46/61 (75.4%) had no VA conduction. After administration of adrenaline, there was VA conduction recovery in 5/46 (10.9%) patients. CONCLUSIONS: Adrenaline infusion produced recovery of VA conduction in 10.9% of patients with absent VA conduction in a basal state. Recovery of VA conduction during physiological or pathological stresses could be responsible for the pacemaker syndrome, PMT episodes, or certain implantable cardiac defibrillator detection issues.

Distance between the Left Atrial Appendage and Mitral Annulus Evaluated by CARTO 3 Integrated Computed Tomography Imaging.

OBJECTIVE: To measure distances between pulmonary veins (PV) and mitral annulus (MA) using angiographic computed tomography (CT) and to compare them with the left atrial appendage-MA (LAA-MA) line. MATERIALS AND METHODS: Data from 46 catheter ablation procedures for atrial fibrillation involving 36 males, mean age 53 years, range 27-78 years, were analyzed. Three types of mitral isthmus lines were measured using angiographic CT images integrated in the CARTO 3 system (Biosense Webster): the distance between the right superior PV and MA (RSPV-MA), the right inferior PV and MA (RIPV-MA), and the left inferior PV and MA (LIPV-MA). They were compared with the length of the LAA-MA line. RESULTS: The mean value of LIPV-MA was 29 ± 11.2 mm, RIPV-MA 39 ± 8.2 mm, and RSPV-MA 48 ± 8.2 mm. The circumflex artery (CxA) and the coronary sinus (CS) were closest to the LIPV-MA line. Compared with the three isthmus lines, the LAA-MA was the shortest (24.7 ± 15.6 mm), and the difference was statistically significant (p < 0.05). CONCLUSION: The angiographic CT provided detailed information regarding the anatomy of the left atrium and distances between atrial structures. The LAA-MA was shorter than the other three lines with the CxA and CS situated at a distance.

The value of adrenaline in the induction of supraventricular tachycardia in the electrophysiological laboratory.

AIMS: The most commonly used drug for the facilitation of supraventricular tachycardia (SVT) induction in the electrophysiological (EP) laboratory is isoprenaline. Despite isoprenaline's apparent indispensability, availability has been problematic in some European countries. Alternative sympatomimethic drugs such as adrenaline have therefore been tried. However, no studies have determined the sensitivity and specificity of adrenaline for the induction of SVT. The objective of this study was to determine the sensitivity and specificity of adrenaline for the induction of SVT. METHODS AND RESULTS: Between February 2010 and July 2013, 336 patients underwent an EP study for prior documented SVT. In 66 patients, adrenaline was infused because tachycardia was not induced under basal conditions. This group was compared with 30 control subjects with no history of SVT. Programmed atrial stimulation was carried out during baseline state and repeated after an infusion of adrenaline (dose ranging from 0.05 mcg/kgc to 0.3 mcg/kgc). The endpoint was the induction of SVT. Among 66 patients with a history of SVT but no induction under basal conditions, adrenaline facilitated induction in 54 patients (82%, P < 0.001). Among the 30 control subjects, SVT was not induced in any patient (0%) after infusion. Adrenaline was generally well tolerated, except for two patients (3.0%), where it had to be discontinued due to headache and high blood pressure or lumbar pain. CONCLUSION: Adrenaline infusion has a high sensitivity (82%) and specificity (100%) for the induction of SVT in patients with prior documented SVT. Therefore, it could serve as an acceptable alternative to isoprenaline, when the latter is not available.

Ischemic stroke risk factors not included in the CHADS-VASC score in patients with non-valvular atrial fibrillation.

BACKGROUND: In patients with atrial fibrillation, the CHA2DS2-VASC score guides stroke prevention using anticoagulants, but it is an imperfect score. Other potential risk factors such as renal failure, the type of atrial fibrillation, active smoking, cancer, sleep apnea or systemic inflammation have less well been investigated. OBJECTIVE: To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation. METHODS: On a population of 248 patients (124 patients with acute ischemic stroke and 124 controls), we performed a logistic regression to assess the impact of multiple non-classic risk factors for the prediction of acute ischemic stroke. Their impact on mortality was assessed by performing a survival analysis. RESULTS: A high CHA2DS2-VASc score (OR 1.75; 95% CI 1.13-2.70; p = 0.032), treatment with anticoagulants (OR 0.19; 95% CI 0.07-0.51; p < 0.001) and permanent atrial fibrillation (OR 6.31; 95% CI 2.46-16.19; p < 0.001) were independently associated with acute ischemic stroke. Renal failure and chronic obstructive pulmonary disease predicted a higher mortality. After adjusting for age, sex, the CHA2DS2-VASc score and the use of anticoagulants, the only risk factor predictive for acute ischemic stroke was the permanent type of AF (OR: 8.0 [95% CI 2.5-25.5], p < 0.001). CONCLUSIONS: The CHA2DS2-VASc score, the absence of anticoagulants and the permanent type of atrial fibrillation were the main predictive factors for the occurrence of acute ischemic stroke. Larger studies are necessary for conclusive results about other factors.

ANTECEDENTES: Em pacientes com fibrilação atrial, o escore CHA2DS2-VASC orienta a prevenção de AVC com anticoagulantes, mas é um escore imperfeito. Outros fatores de risco potenciais, como insuficiência renal, o tipo de fibrilação atrial, tabagismo ativo, câncer, apnéia do sono ou inflamação sistêmica foram menos bem investigados. OBJETIVO: Avaliar o impacto desses fatores no risco de AVC isquêmico em pacientes com fibrilação atrial não valvular. MéTODOS: Em uma população de 248 pacientes (124 pacientes com AVC isquêmico agudo e 124 controles), realizamos uma regressão logística para avaliar o impacto de múltiplos fatores de risco não clássicos na predição de AVC isquêmico agudo. O seu impacto na mortalidade foi avaliado através da realização de uma análise de sobrevivência. RESULTADOS: Escore CHA2DS2-VASc alto (OR 1,75; IC 95% 1,13­2,70; p = 0,032), tratamento com anticoagulantes (OR 0,19; IC 95% 0,07­0,51; p < 0,001) e fibrilação atrial permanente (OR 6,31; 95% CI 2,46­16,19; p < 0,001) foram independentemente associados ao AVC isquêmico agudo. Insuficiência renal e doença pulmonar obstrutiva crônica previram maior mortalidade. Após ajuste para idade, sexo, pontuação CHA2DS2-VASc e uso de anticoagulantes, o único fator de risco preditivo para AVC isquêmico agudo foi o tipo permanente de FA (OR: 8,0 [IC 95% 2,5­25,5], p < 0,001). CONCLUSõES: O escore CHA2DS2-VASc, a ausência de anticoagulantes e o tipo permanente de fibrilação atrial foram os principais fatores preditivos para a ocorrência de AVC isquêmico agudo. Estudos maiores são necessários para resultados conclusivos sobre outros fatores.

Body size influences heart rate in children aged 6 to 18 years old.

Previous research established age-related normal limits for children's heart rates (HRs). However, children of the same age can have significantly different HRs, depending on whether they are overweight or underweight, tall or short. Studies on children HR have failed to find a clear correlation between HR and body size. The goal of our study was to create Z scores for HR based on weight (W), height (H), body mass index (BMI), and body surface area (BSA) and compare them to normal age-related HR limits. Electrocardiograms were recorded from a total of 22,460 healthy children ranging in age from 6 to 18 years old using BTL machines. A comparison was made between different age groups, in function of W, H, BMI, and BSA, based on the HR that was automatically detected by using the digitally stored electrocardiogram. Z scores were computed for each of the categories that were mentioned. Incremental Z score values between -2.5 and 2.5 were calculated to establish upper and lower limits of HR. The BSA's estimation of HR is the most accurate of the available methods and can be utilized with accuracy in clinical practice. Z scores for HR in children differ in function of the age, W, H, BMI and BSA. The best estimation is based on BSA. The novelty of our study is that we developed Z scores for HR in relation to body size, age and sex, producing a standardized, consistent, and reproducible result without requiring practitioners to learn and remember cutoff values for a wide range of variables across age groups and sexes. Z scores minimize observer and institutional bias, hence generating uniform and reproducible standards.

Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study.

BACKGROUND: Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study. METHODS: Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared. RESULTS: Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13-2.23]; P=0.006). CONCLUSIONS: In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.

Safety and efficacy of programming a high number of antitachycardia pacing attempts for fast ventricular tachycardia: a prospective study.

AIMS: Little is known about the optimal number of antitachycardia pacing (ATP) attempts to programme in the fast ventricular tachycardia (FVT) zone. We sought to analyse the long-term efficacy and safety of programming a high number of ATP attempts for FVTs. METHODS AND RESULTS: All patients receiving an implantable cardioverter/defibrillator (ICD) for coronary artery disease or dilated cardiomyopathy for primary and secondary prevention between 2000 and 2009 were prospectively included. Implantable cardioverter/defibrillators were programmed to deliver 10 ATP attempts for FVT cycle lengths (CLs) of 250-300 ms (200-240 b.p.m.) before shock delivery (5 bursts, then 5 ramps; 8-10 extrastimuli at 81-88% FVT CL; minimal pacing CL 180 ms). Among 770 patients included and followed for 40.6 ± 25.6 months, 137 (17.8%) experienced a total of 1839 FVTs, 1713 of which were ATP-terminated (unadjusted efficacy = 93.1%, adjusted = 81.7%), 106 ATP-accelerated (5.8%), and 20 ATP-resistant (1.1%). The majority of FVT episodes were successfully treated by one or two attempts (98.3%). However, patient-based analysis showed that 17 (12.4%), 8 (5.8%), and 5 patients (2.1%) had at least one episode treated by three or more, four or more, and five or more ATP attempts. The benefit of this strategy was reduced after five attempts. The majority of FVT episodes was asymptomatic and diagnosed at device interrogation during follow-up: syncope and pre-syncope occurred in only 0.2 and 0.4% of episodes, respectively. CONCLUSION: Programming a high number of ATP attempts (up to five ATP attempts) in the FVT zone is both safe and efficient and could prevent shocks in numerous ICD recipients.

Showing up channels for postinfarct ventricular tachycardia ablation.

The number of scar-related ventricular tachycardia (VT) ablation procedures is increasing worldwide. This is certainly due to the ever growing number of patients implanted with an implantable cardioverter defibrillator in whom an ablation procedure may be required to better control the ventricular arrhythmia burden, but is also likely related to our better understanding of the arrhythmias mechanisms as well as the improvement of the mapping techniques during the last 15 years. Most VTs, especially those arising after myocardial infarction, depend on a critical isthmus. Defining precisely the critical isthmus of postinfarct VT may be challenging, particularly when the arrhythmia is poorly tolerated. In the literature, there are extensive data concerning the value of conventional electrophysiological techniques, especially entrainment mapping in association with postpacing interval measurements, regarding the identification of postinfarct VT isthmuses. There are, however, other--sometimes emerging--approaches to image critical postinfarct VT channels. We have summarized these, reviewing data from the published literature as well as our own experience.

Nursing procedures for advanced dementia: Traditional techniques versus autonomous robotic applications (Review).

The purpose of this study was to perform a comparative analysis of traditional nursing techniques and autonomous robotic applications used for managing patients with advanced stages of dementia. PubMed, Cochrane Library, EMBASE, and WILEY databases were searched for relevant articles concerning nursing techniques applied in the treatment of patients with advanced dementia. The search terms included: (advanced dementia OR severe dementia) AND [artificial intelligence (AI) OR robotic OR robots OR neural networks OR deep learning OR automated procedures OR autonomous application]. This search identified a total of 2,679 articles and 298 articles were selected. Finally, 23 articles were included in this systematic review, out of which 8 studies analyzed traditional nursing techniques and 15 studies analyzed autonomous robotic applications. Significant evidence was revealed, demonstrating that autonomous robotic applications used for patients with advanced stages of dementia are a feasible, cost-efficient solution and represent an excellent benefit for patients and the healthcare system.

The Pathogenesis of Cardiac Arrhythmias in Vitamin D Deficiency.

The global prevalence of vitamin D deficiency is more than 20%, and the main causes include insufficient intake, reduced absorption, abnormal metabolism, or resistance to its effects. The levels of serum vitamin D appear to influence cardiovascular risk, and the mechanism involved is linked to the transient outward current and the ultrarapid delayed rectifier K+ current densities, activated through the nuclear vitamin D receptor and Akt pathway. A significant number of studies have correlated vitamin D deficiency with an increased risk of developing cardiac arrhythmias and sudden cardiac death. For this reason, the purpose of this review is to analyze the relation between vitamin D deficiency and the pathogenesis of cardiac arrhythmias. Atrial fibrillation, increased QT interval, and QT dispersion were the most common findings associated with vitamin D deficiency. Due to the heterogeneity among existing studies, further research is necessary to confirm the existing data and to analyze its relationship with other types of arrhythmias.

Low Atrial Rhythm in a Large Cohort of Children from Transylvania, Romania.

Low atrial rhythm (LAR) is an ectopic rhythm originating in the lower part of the right or left atrium. Prior observational studies attempted to quantify the prevalence of low atrial rhythm in the pediatric population, but the observed prevalence was highly variable with relatively small sample sizes. We aimed to characterize low atrial rhythm and determine its prevalence in a large population of 24,316 asymptomatic children from northwestern Transylvania. We found a prevalence of 0.6% (145 children) for low atrial rhythm. Children with LAR had a significantly lower heart rate (mean 78.6 ± 8.3 bpm), than the control sinus rhythm group (85.02 ± 4.5 bpm). Furthermore, a shorter PR interval was seen in children with LAR (132.7 ± 12.7 ms) than in the children from the control group (141.7 ± 5.4; p = 0.0001).There was no significant association between gender and the presence of left LAR (LLAR) or right LAR (RLAR) (p = 0.5876). The heart rate of children with LLAR was significantly higher (81.7 ± 11.6 bpm) than that of the children with LRAR (77.6 ± 11.1 bpm) (p = 0.037). Pediatric cardiologists should recognize low atrial rhythm and be aware that asymptomatic, healthy children can exhibit this pattern, which does not require therapeutic intervention.

Incidental extracardiac findings in cardiac computed tomography performed before radiofrequency ablation of atrial fibrillation.

BACKGROUND: Radiofrequency ablation has became a validated therapeutic technique for symptomatic drug refractory atrial fibrillation (AF). Cardiac computed tomography (CT) is used to evaluate left atrial (LA) anatomy in order to improve AF ablation. The analysis of noncardiac structures during cardiac CT may identify clinically significant incidental findings (IFs). The objective of this study was to determine the prevalence of IF in patients undergoing AF catheter ablation. METHODS: Between February 2008 and March 2010, all patients planned for a first procedure of AF or LA tachycardia (LAT) ablation underwent a cardiac CT scan and were retrospectively included in this study. Extracardiac IFs were considered to be present if an abnormality was identified without previous clinical suspicion or known disease. RESULTS: Two hundred and fifty patients (55.2 ± 9.6 years of age, 82.4% men) were enrolled (133 paroxysmal, 43 persistent, 58 permanent AF, and 16 LAT). Fifty-eight patients (23.2%) had a total of 76 IFs. Patients with IF were significantly older (59.5 ± 8.2 vs 53.8 ± 9.7 years old, P < 0.001). No relationship existed between the type of arrhythmia and IF existence. The majority of IFs were pulmonary (50%), with 15.8% of pulmonary emphysema. Two cases of lung cancer and of pulmonary fibrosis, 15 mediastinal adenopathies, and three congenital coronary arteries anomalies were found. CONCLUSIONS: Cardiac CT scan is a useful tool to evaluate LA morphology before AF ablation. However, as a considerable prevalence of IF was found in our study, extracardiac structures should be routinely analyzed to detect unknown conditions, which could require specific management.

Formula to estimate left atrial volume using antero-posterior diameter in patients with catheter ablation of atrial fibrillation.

ABSTRACT: In patients undergoing atrial fibrillation (AF) ablation, an enlarged left atrium (LA) is a predictor of procedural failure as well as AF recurrence on long term. The most used method to assess LA size is echocardiography-measured diameter, but the most accurate remains computed tomography (CT).The aim of our study was to determine whether there is an association between left atrial diameters measured in echocardiography and the left atrial volume determined by CT in patients who underwent AF ablation.The study included 93 patients, of whom 60 (64.5%) were men and 64 (68.8%) had paroxysmal AF, who underwent AF catheter ablation between January 2018 and June 2019. Left atrial diameters in echocardiography were measured from the long axis parasternal view and the LA volume in CT was measured on reconstructed three-dimensional images.The LA in echocardiography had an antero-posterior (AP) diameter of 45.0 ±â€Š6 mm (median 45; Inter Quartile Range [IQR] 41-49, range 25-73 mm), longitudinal diameter of 67.5 ±â€Š9.4 (median 66; IQR 56-88, range 52-100 mm), and transversal diameter of 42 ±â€Š8.9 mm (IQR 30-59, range 23-64.5 mm). The volume in CT was 123 ±â€Š29.4 mL (median 118; IQR 103-160; range 86-194 mL). We found a significant correlation (r = 0.702; P < .05) between the AP diameter and the LA volume. The formula according to which the AP diameter of the LA can predict the volume was: LA volume = AP diam3 + 45 mL.There is a clear association between the left atrial AP diameter measured on echocardiography and the volume measured on CT. The AP diameter might be sufficient to determine the increase in the volume of the atrium and predict cardiovascular outcomes.

Validation of Normal P-Wave Parameters in a Large Unselected Pediatric Population of North-Western Romania: Results of the CARDIOPED Project.

AIMS: Reference values of the P-wave on 12 lead electrocardiograms are lacking for children and adolescents in Eastern Europe. Hence, the present study is aimed at determining the standard values of the P-wave in children and adolescents based on ECG data from the CARDIOPED project, a large-scale general population of children who participated in a screening program in Transylvania, Romania. METHODS AND RESULTS: A total of 22,411 ECGs of participants aged 6 to 18 years old from a school-based ECG screening were obtained between February 2015 and December 2015 in Transylvania, Romania. Three pediatric cardiologists manually reviewed each ECG. P-wave duration, voltage, axis, and correlation with gender and age were analyzed. The mean P-wave duration was 88 ± 10.7 ms, with a maximum duration of 128 ms. P-wave showed a positive correlation with age but did not differ between sexes. There was a positive correlation between the P-wave duration and the heart rate, but not with the body max index. The mean P-wave axis was 40.4 ± 31.1, and the mean P-wave amplitude was 0.12 ± 0.03 mV. CONCLUSION: In this study on many pediatric subjects, we have provided normal limits for the P-wave in Romanian children aged 6-18 years. Our findings are useful for creating interpretation guidelines for pediatric ECG.

Life-threatening complications of hyperemesis gravidarum.

Hyperemesis gravidarum (HG) refers to severe nausea and emesis noted during pregnancy. However, no consensus exists on the specific diagnostic criteria that can be used for this condition. The aim of the present systematic review was to summarize the available evidence regarding the severe complications observed during HG with a heightened risk of fatality. A systematic search was conducted on PubMed, Cochrane Library, EMBASE and WILEY databases for the relevant publications regarding the severe and life-threatening complications of HG. The search terms were as follows: '(Hyperemesis gravidarum)' AND ('complications' OR 'severe' OR 'adverse pregnancy outcomes' OR 'stroke' OR 'seizures' OR 'Wernicke's encephalopathy' OR 'arrhythmias' OR 'pneumomediastinum' OR 'coagulopathy' OR 'electrolytic imbalance'). Abstracts, conference presentations, letters to the editor, studies written in languages other than English and editorials were all excluded. This search identified 43 studies analyzing life-threatening complications of HG, of which 11, seven, eight and 17 articles analyzed neurological, cardiovascular, thoracic and systemic complications, respectively. Reports on life-threatening complications were exceptionally rare in HG. The most frequent severe complications noted were Wernicke's encephalopathy, electrolyte imbalance and vitamin K deficiency. The low mortality rate for patients with HG over the last decade could be explained by the high efficiency of modern therapy, and the precise management of every complication according to current guidelines.

Artificial Intelligence and Antibiotic Discovery.

Over recent decades, a new antibiotic crisis has been unfolding due to a decreased research in this domain, a low return of investment for the companies that developed the drug, a lengthy and difficult research process, a low success rate for candidate molecules, an increased use of antibiotics in farms and an overall inappropriate use of antibiotics. This has led to a series of pathogens developing antibiotic resistance, which poses severe threats to public health systems while also driving up the costs of hospitalization and treatment. Moreover, without proper action and collaboration between academic and health institutions, a catastrophic trend might develop, with the possibility of returning to a pre-antibiotic era. Nevertheless, new emerging AI-based technologies have started to enter the field of antibiotic and drug development, offering a new perspective to an ever-growing problem. Cheaper and faster research can be achieved through algorithms that identify hit compounds, thereby further accelerating the development of new antibiotics, which represents a vital step in solving the current antibiotic crisis. The aim of this review is to provide an extended overview of the current artificial intelligence-based technologies that are used for antibiotic discovery, together with their technological and economic impact on the industrial sector.

Factors likely to affect the long-term results of ventricular stimulation after myocardial infarction.

BACKGROUND: The results of programmed ventricular stimulation (PVS) may change after myocardial infarction (MI). The objective was to study the factors that could predict the results of a second PVS. METHODS: Left ventricular ejection fraction (LVEF) and QRS duration were determined and PVS performed within 3 to 14 years of one another (mean 7.5+/-5) in 50 patients studied systematically between 1 and 3 months after acute MI. RESULTS: QRS duration increased from 120+/-23 ms to 132+/-29 (p 0.04). LVEF did not decrease significantly (36+/-12 % vs 37+/-13 %). Ventricular tachycardia with cycle length (CL) > 220ms (VT) was induced in 11 patients at PVS 1, who had inducible VT with a CL > 220 ms (8) or < 220 ms (ventricular flutter, VFl) (3) at PVS 2. VFl or fibrillation (VF) was induced in 14 patients at PVS 1 and remained inducible in 5; 5 patients had inducible VT and 4 had a negative 2nd PVS. 2. 25 patients had initially negative PVS; 7 had secondarily inducible VT, 4 a VFl/VF, 14 a negative PVS. Changes of PVS were related to initially increasing QRS duration and secondarily changes in LVEF and revascularization but not to the number of extrastimuli required to induce VFl. CONCLUSIONS: In patients without induced VT at first study, changes of PVS are possible during the life. Patients with initially long QRS duration and those who developed decreased LVEF are more at risk to have inducible monomorphic VT at 2nd study, than other patients.