Heart Rate Variability and Coronary Artery Bypass Grafting: A Systematic Review.

Background: Coronary artery bypass grafting (CABG) is a well-established surgical procedure used to treat significant coronary artery disease. Nevertheless, unfavorable cardiovascular events and complications, including cardiac arrhythmias may be observed in patients after CABG. Previous studies have revealed a relationship between risk of cardiac arrhythmias and abnormal heart rate variability (HRV), which reflects adverse alterations in cardiac autonomic functioning, that may occur in patients after a CABG procedure. The aim of this article was to provide a systematic review of the major research findings in this area. Methods: A literature search was carried out using PubMed, Cochrane, and Embase databases and relevant articles, published in English, were analyzed in detail. Results: Studies performed so far have shown time depending changes in HRV after CABG. Time and frequency domain HRV decrease acutely after CABG but recover almost completely to pre-operative values by 6 months after surgery. Some preoperative clinical states such as: heart failure, type 2 diabetes mellitus and depression adversely affect post-CABG HRV. Finally, post-CABG cardiac rehabilitation appears to improve exercise capacity and speed up recovery of HRV. Conclusions: Generally, traditional time and frequency domain HRV parameters fail to predict complications post-CABG. Altered non-linear measures of HRV may identify subgroups of subjects at increased risk of potential complications, including atrial fibrillation post-CABG. However, data available currently does not appear to unequivocally support the hypothesis that early HRV assessment in post-CABG patients predicts long-term mortality.

Superior vena cava isolation using a pentaspline pulsed-field ablation catheter: feasibility and safety in patients undergoing atrial fibrillation catheter ablation.

AIMS: Superior vena cava (SVC) isolation during atrial fibrillation catheter ablation is limited by the risk of collateral damage to the sinus node and/or the phrenic nerve. Due to its tissue-specificity, we hypothesized the feasibility and safety of pulsed-field ablation (PFA)-based SVC isolation. METHODS AND RESULTS: One hundred and five consecutive patients undergoing PFA-based AF catheter ablation were prospectively included. After pulmonary vein isolation (±posterior wall isolation and electrical cardioversion), SVC isolation was performed using a standardized workflow. Acute SVC isolation was achieved in 105/105 (100%) patients after 6 ± 1 applications. Transient phrenic nerve stunning occurred in 67/105 (64%) patients but without phrenic nerve palsy at the end of the procedure and at hospital discharge. Transient high-degree sinus node dysfunction occurred in 5/105 (4.7%) patients, with no recurrence at the end of the procedure and until discharge. At the 3-month follow-up visit, no complication occurred. CONCLUSION: SVC isolation using a pentaspline PFA catheter is feasible and safe.

Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis.

The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.

New Frontiers in Electrocardiography, Cardiac Arrhythmias, and Arrhythmogenic Disorders.

In recent decades, diagnosing, risk-stratifying, and treating patients with primary electrical diseases, as well as heart rhythm disorders, have improved substantially [...].

Importance of Comprehensive Assessment in Brugada Syndrome. Reply to Kataoka, N.; Imamura, T. How to Diagnose and Risk Stratify Brugada Syndrome. Comment on "Matusik et al. Twelve-Lead ECG, Holter Monitoring Parameters, and Genetic Testing in Brugada Syndrome: Insights from Analysis of Multigenerational Family with a History of Sudden Cardiac Arrest during Physical Activity. J. Clin. Med. 2023, 12, 6581".

We would like to thank Dr. Imamura for their interest in our study and their valuable comments on diagnostics and risk stratification in Brugada syndrome (BrS) [...].

Altered fibrin clot properties are associated with the progression of chronic kidney disease in atrial fibrillation.

INTRODUCTION: Formation of denser and resistant to lysis fibrin clot networks has been shown in chronic kidney disease (CKD) and atrial fibrillation (AF). We investigated whether such prothrombotic fibrin clot properties are associated with faster progression of CKD in AF patients. MATERIAL AND METHODS: We recruited 265 AF patients (men 49.1 %, median age of 64.0 years, median estimated glomerular filtration rate [eGFR] of 77.0 ml/min/1.73 m2), including 137 patients on non-vitamin K antagonist oral anticoagulants (NOACs) (51.7 %) and 109 patients (41.1 %) on vitamin K antagonists (VKAs). At baseline while off anticoagulation, we determined fibrin clot permeability (Ks), and clot lysis time (CLT), along with plasminogen activator inhibitor-1 (PAI-1), endogenous thrombin potential (ETP), and von Willebrand factor (vWF). The kidney function was assessed at baseline and after a median follow-up of 50.0 months. RESULTS: During follow-up, a median eGFR decreased by 8.0 (5.0-11.0) ml/min/1.73 m2, 1.8 ml/min/1.73 m2/year and this change correlated with age (R = 0.19, P = 0.002), Ks (R = 0.46, P < 0.0001), and CLT (R = -0.17, P = 0.005), but not ETP, fibrinogen, PAI-1 or vWF. A decrease in eGFR was lower in patients who used NOACs at baseline but not in those who started NOACs during follow-up (n = 101) as compared to the remaining patients. On multiple linear regression analysis, adjusted for age and fibrinogen, baseline Ks, eGFR, hypertension, and NOACs use independently predicted a decrease in eGFR. CONCLUSIONS: This study is the first to show that more compact fibrin clot networks may contribute to faster progression of CKD in AF, indicating novel kidney-related harmful effects of prothrombotic clot properties in humans.

NGS analysis of collagen type I genes in Polish patients with Osteogenesis imperfecta: a nationwide multicenter study.

Osteogenesis imperfecta (OI) is a rare genetic disorder of the connective tissue. It presents with a wide spectrum of skeletal and extraskeletal features, and ranges in severity from mild to perinatal lethal. The disease is characterized by a heterogeneous genetic background, where approximately 85%-90% of cases have dominantly inherited heterozygous pathogenic variants located in the COL1A1 and COL1A2 genes. This paper presents the results of the first nationwide study, performed on a large cohort of 197 Polish OI patients. Variants were identified using a next-generation sequencing (NGS) custom gene panel and multiplex ligation probe amplification (MLPA) assay. The following OI types were observed: 1 (42%), 2 (3%), 3 (35%), and 4 (20%). Collagen type I pathogenic variants were reported in 108 families. Alterations were observed in α1 and α2 in 70% and 30% of cases, respectively. The presented paper reports 97 distinct causative variants and expands the OI database with 38 novel pathogenic changes. It also enabled the identification of the first glycine-to-tryptophan substitution in the COL1A1 gene and brought new insights into the clinical severity associated with variants localized in "lethal regions". Our results contribute to a better understanding of the clinical and genetic aspects of OI.

Twelve-Lead ECG, Holter Monitoring Parameters, and Genetic Testing in Brugada Syndrome: Insights from Analysis of Multigenerational Family with a History of Sudden Cardiac Arrest during Physical Activity.

Brugada syndrome (BrS) is an arrhythmogenic disorder increasing the risk of syncopal episodes and sudden cardiac death. BrS usually runs through families with reduced penetrance and variable expression. We analyzed the multigenerational family of a patient who died after sudden cardiac arrest with post-mortem diagnosis of BrS. We analyzed clinical history, comprehensive arrhythmic risk, genetic findings, and additional tests, including electrocardiogram (ECG), detailed 24-hour Holter ECG results, and standard echocardiography findings, and followed up the patients in the ambulatory clinic. We analyzed a pedigree of 33 members of four generations of the family (19 male and 14 female patients). In this family, we identified 7 patients with BrS (median Modified Shanghai Score and Sieira model: 4.5 (4-6) and 1 (0-4) points, respectively), including both parents of the deceased patient, and 8 relatives with negative sodium channel blocker drug challenge test. Genetic testing revealed a novel mutation in sodium voltage-gated channel alpha subunit 5 (SCN5A) c.941A>G, (p.Tyr314Cys) inherited from the father of the proband. Patients with BrS were characterized by longer P-wave duration (120 (102-155) vs. 92.5 (88-110) ms, p = 0.013) and longer PR intervals (211.3 ±26.3 vs. 161.6 ± 18.9 ms, p = 0.001), along with more frequent positive aVR sign, but did not differ in terms of QRS duration or T-wave characteristics in resting ECGs. BrS patients were characterized by lower mean, minimal, and maximal (for all p ≤ 0.01) heart rates obtained from Holter ECG monitoring, while there was no difference in arrhythmias among investigated patients. Moreover, visual diurnal variability of ST segment changes and fragmented QRS complexes were observed in patients with BrS in Holter ECG monitoring. There were no major arrhythmic events during median follow-up of 68.7 months of alive BrS patients. These results suggest ECG features which may be associated with a diagnosis of BrS and indicate a novel SCN5A variant in BrS patients. Twelve-lead Holter ECG monitoring, with modified precordial leads placement, may be useful in BrS diagnostics and risk stratification in personalized medicine.

Skeletal muscle mass, muscle strength, and physical performance in children and adolescents with obesity.

Introduction: Sarcopenic obesity (SO) is defined as obesity with low skeletal muscle function and mass. This study aimed to evaluate the presence of sarcopenic obesity according to different diagnostic criteria and assess the elements of sarcopenia in children and adolescents with obesity. Methods: A total of 95 children and adolescents with obesity (diagnosed with the use of International Obesity Task Force (IOTF) criteria) with a mean age of 12.7( ± 3) years participated in the study. Body composition was assessed with the use of bioelectrical impedance-BIA (Tanita BC480MA) and dual-energy X-ray absorptiometry-DXA (Hologic). Fat mass (FM) and appendicular skeletal muscle mass (SMMa) were expressed as kilograms (kg) and percentage (%). Muscle-to-fat ratio (MFR) was defined as SMMa divided by FM. A dynamometer was used in order to measure grip strength. Six-minute walk test (6MWT) and a timed up-and-go test (TUG) were used to assess physical performance. Results: The presence of SO ranged from 6.32% to 97.89%, depending on the criteria used to define sarcopenia. Children with sarcopenia, defined as a co- occurrence of low skeletal muscle mass % (SMM%) measured by DXA (≤9th centile) according to McCarthy et al. and weak handgrip strength (≤10th centile) according to Dodds et al., had significantly lower SMMa measured by both DXA and BIA, lower maximal handgrip strength, and lower physical performance. Maximal handgrip was positively correlated with SMMa (kg) and SMMa% derived from both DXA and BIA and BIA-MFR. Maximal handgrip was negatively correlated with waist-to-height ratio (WHtR). The distance of 6MWT correlated positively with BIA-measured SMMa% and BIA-MFR. 6MWT distance correlated negatively with BIA-FM% and body mass index (BMI) z-score. TUG was positively correlated with BIA-FM%, BMI z-score, WHtR, and IOTF categories and negatively correlated with BIA-SMMa% and BIA-MFR. Discussion: The presence of sarcopenia in our study varied depending on the diagnostic criteria used. This is one of the first studies evaluating muscle mass, muscle strength, and physical performance in children and adolescents with obesity. The study highlighted the need for the implementation of a consensus statement regarding SO diagnostic criteria in children and adolescents.

Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management.

Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.

Are menstrual disorders in adolescent girls related to metabolic disorders?

INTRODUCTION: Menstrual disorders in adolescent girls are a common clinical problem. They are often accompanied by lipid and glucose metabolism disturbances. The aim of the study was to investigate to what extent the metabolic profile of adolescent girls relates to the severity of their menstrual disorders. MATERIAL AND METHODS: The study included 165 girls with menstrual disturbances and 49 regularly menstruating girls (REG) without clinical hyperandrogenism, matched for age and BMI. The subjects from the study group were divided into 2 subgroups: OLIGO - 111 girls with oligomenorrhea and SA - 54 girls with secondary amenorrhoea. In all girls, hormonal, lipid, and carbohydrate metabolism profiles were assessed. RESULTS: In the SA subgroup concentrations of total cholesterol (TC) and LDL were significantly higher than in the REG and OLIGO groups. Triglyceride (TG) concentration was also the highest in the SA group and significantly higher than in the REG group. The prevalence of lipid metabolism disorders was higher in the SA group (65%) vs. the REG (40%) and OLIGO (51%) groups. The subgroups did not differ significantly in terms of fasting and OGTT glucose and insulin as well as HOMA-IR. TyG index was significantly higher in the OLIGO and SA groups than in the REG group. BMI z-score correlated with TG, LDL, fasting and 120' OGTT glucose and insulin, HOMA-IR, and TyG and negatively with HDL. No relationship between hormonal concentration and metabolic disturbances was found. CONCLUSIONS: Adolescent girls with menstrual disorders are insulin resistant, regardless of PCOS diagnosis. The severity of menstrual disorders may be related to the incidence of lipid disorders in adolescent girls.

Corrigendum: Sarcopenic obesity in children and adolescents: a systematic review.

[This corrects the article DOI: 10.3389/fendo.2022.914740.].

Infections of cardiac implantable electronic devices: Epidemiology, mechanisms, and preventive measures.

Cardiac implantable electronic device (CIED) infections represent a complication associated with high morbidity and mortality. Despite enormous efforts to prevent them, the rates of infections continue to rise out of proportion to the reported increase in CIED implantation rates. Following extensive research of various prevention strategies and new technologies, several organizations have issued recommendations and consensus papers covering this topic. Our narrative review aims to provide a summary of the existing preventive strategies put forward by the European Heart Rhythm Association consensus and European Society of Cardiology guidelines and introduce the most recent developments in the field, including optimized surgical site management and appropriate periprocedural antithrombotic drug use. It also provides an overview of epidemiology, mechanisms, risk factors, and risk stratification approaches. It focuses on the pre-, intra-, and postprocedural actions that should be taken to mitigate CIED infection risks. Future directions in the prevention of CIED infections have also been addressed.

Vitamin D Deficiency in Obese Children Is Associated with Some Metabolic Syndrome Components, but Not with Metabolic Syndrome Itself.

Vitamin D deficiency in children is a common nutritional issue in many populations worldwide, associated not only with skeletal malformations but, as recent studies suggest, also with the development of obesity and metabolic syndrome. The aim of this observational study was to assess the nutritional status of vitamin D in a group of Polish children with obesity and different grades of metabolic syndrome, with a consequent analysis of the correlation between vitamin D levels and the components of metabolic syndrome. For that purpose, the group of 78 participants (mean age: 14.18 ± 2.67 years) was recruited and further grouped in relation to vitamin D status into two groups of children with and without vitamin D deficiency. The biochemical parameters associated with obesity as well as anthropometric measures were assessed and analysed in search of significant differences between the groups. In the current group of children with obesity and vitamin D deficiency, HDL (45.00 ± 9.29) and adiponectin (7.21 ± 1.64) were found to be significantly lower than in their peers without vitamin D deficiency, whereas W/HtR (0.60 ± 0.04) and TG (171.31 ± 80.75) levels proved to be significantly higher. Body composition analysis using bioelectrical impedance returned no significant findings. The above findings suggest that vitamin D deficiency may influence lipid and glucose metabolism in children, leading to the development of abnormalities characteristic of the metabolic syndrome. A W/HtR parameter was shown to be a sensitive marker of abdominal obesity, which might provide an important means of assessing the correlation between vitamin D and this type of obesity. Independently, vitamin D deficiency may also influence the endocrinological function of adipose tissue, leading to lower concentrations of adiponectin. These in turn presented a linear correlation with the high results of the OGTT in the second hour of the test, hinting at its potential role in the pathophysiology of insulin resistance.

Neutrophil-activating Peptide 2 as a Novel Modulator of Fibrin Clot Properties in Patients with Atrial Fibrillation.

Neutrophil-activating peptide 2 (NAP-2, CXCL7), a platelet-derived neutrophil chemoattractant, is involved in inflammation. We investigated associations between NAP-2 levels, neutrophil extracellular traps (NETs) formation, and fibrin clot properties in atrial fibrillation (AF). We recruited 237 consecutive patients with AF (mean age, 68 ± 11 years; median CHA2DS2VASc score of 3 [2-4]) and 30 apparently healthy controls. Plasma NAP-2 concentrations were measured, along with plasma fibrin clot permeability (Ks) and clot lysis time (CLT), thrombin generation, citrullinated histone H3 (citH3), as a marker of NETs formation, and 3-nitrotyrosine reflecting oxidative stress. NAP-2 levels were 89% higher in AF patients than in controls (626 [448-796] vs. 331 [226-430] ng/ml; p < 0.0001). NAP-2 levels were not associated with demographics, CHA2DS2-VASc score, or the AF manifestation. Patients with NAP-2 in the top quartile (> 796 ng/ml) were characterized by higher neutrophil count (+ 31.7%), fibrinogen (+ 20.8%), citH3 (+ 86%), and 3-nitrotyrosine (+ 111%) levels, along with 20.2% reduced Ks and 8.4% prolonged CLT as compared to the remaining subjects (all p < 0.05). NAP-2 levels were positively associated with fibrinogen in AF patients (r = 0.41, p = 0.0006) and controls (r = 0.65, p < 0.01), along with citH3 (r = 0.36, p < 0.0001) and 3-nitrotyrosine (r = 0.51, p < 0.0001) in the former group. After adjustment for fibrinogen, higher citH3 (per 1 ng/ml ß = -0.046, 95% CI -0.029; -0.064) and NAP-2 (per 100 ng/ml ß = -0.21, 95% CI -0.14; -0.28) levels were independently associated with reduced Ks. Elevated NAP-2, associated with increased oxidative stress, has been identified as a novel modulator of prothrombotic plasma fibrin clot properties in patients with AF.

Multiparametric Cardiac Magnetic Resonance and Arrhythmias in Myocarditis.

Myocarditis is an inflammatory disease of the myocardium with a wide range of potential etiological factors, including a variety of infectious agents (mainly viral), systemic diseases, drugs, and toxins.

Dyadic Predictors of Willing to Engage in Physical Activity and Emotional Eating in Children and Adolescents with Mild and Moderate Intellectual Disability.

Intellectual disability is associated with increased risk for childhood obesity, and the factors most often associated with this risk are incorrect eating behavior and insufficient amount and intensity of physical activity. As is well known, there area whole range of factors determining lifestyle, but many currently available reports in this field refer to the functioning of children without a diagnosis of intellectual disability, and, as we know, due to numerous individual and environmental barriers, children with ID may function differently in this context than their peers. Therefore, we examined the relationships between the selected variables and divided them into two models: (1) first regression model: child's willingness to engage in physical activity (dependent variable), child's physical limitations related to disabilities and/or comorbidities, child's independence, parents' willingness to engage in physical activity, child's body dissatisfaction (independent variables/predictors); (2) second regression model: child's emotional eating (dependent variable), child's coping with emotions, parents' attitudes, beliefs, and practices about child feeding (restriction and pressure to eat), parents' emotional eating, parents' happiness (independent variables/predictors). A group of 503 parents (of children and adolescents with mild and moderate intellectual disability) completed: the Contour Drawing Rating Scale, the Child Feeding Questionnaire, the Emotional Overeating Questionnaire, the Scale of Experiencing Happiness, and the supplementary survey. Our results allow partial confirmation of the hypotheses related to both of these models: (1) model I: the relationships between the child's willingness to engage in physical activity and all predictors are significant, but the direction of the relationship between the dependent variable and one of the predictors-body dissatisfaction-is opposite to the assumed one (negative relationship); (2) model II: the relationships between the child's emotional eating and almost all predictors are significant, except for the relationship between the dependent variable and pressure to eat. In conclusion, (to the authors' knowledge) this study is the first to assess dyadic predictors of willingness to engage in physical activity and emotional eating in children and adolescents with mild and moderate intellectual disability. It allows for a better understanding of the attitudes, beliefs, and experiences of children with intellectual disabilities and their parents, which gives the opportunity (taking into account factors from both individuals from the child-parent dyad) to better design strategies to support pro-health behaviors in children and adolescents from this group (which may improve the effectiveness of overweight prevention and obesity). These findings emphasize how important it is to consider the dynamic of the child-parent dyad when considering how parenting contributes to a child's willingness to engage in physical activity, as well as thatchild's emotional eating.

Avoidant/Restrictive Food Disorder (ARFID), Food Neophobia, Other Eating-Related Behaviours and Feeding Practices among Children with Autism Spectrum Disorder and in Non-Clinical Sample: A Preliminary Study.

Previous research shows that children with autism spectrum disorder (ASD) may experience several difficulties-including those related to eating-and this area of research needs to be explored further. This study had two main objectives: (1) comparison of the clinical (autism spectrum disorder) and non-clinical sample of children in terms of avoidant/restrictive food disorder, food neophobia, other eating-related behaviours and feeding practices; (2) assessment of selected predictors of food neophobia. The final sample included 54 children and parents from the clinical sample (ASD) and 51 from the non-clinical sample. Parents completed: the autism spectrum rating scales (ASRS), the eating disorders in youth questionnaire (EDY-Q), the children food neophobia scale (CFNS), the child eating behaviour questionnaire (CEBQ), the child feeding questionnaire (CFQ), and a socio-demographic survey. Our analysis allowed us to partially confirm the first hypothesis since the clinical sample (vs. the non-clinical group) had significantly higher scores in such variables as (a) avoidant/restrictive food disorder (ARFID), (b) food neophobia, (c) other eating-related behaviours: emotional under-eating, desire to drink, food fussiness, (d) feeding practices: pressure to eat. Moreover, our analysis of predictors of food neophobia in the clinical and non-clinical samples also allowed us to partially confirm the second hypothesis because it turned out that only in the clinical sample (vs. the non-clinical sample) were the predictors significantly associated with food neophobia, but only two of them (food fussiness and selective eating). In conclusion, our study showed that children with ASD (compared to children without this diagnosis) experience increased difficulties in eating behaviours, and their parents present a stronger intensity of the feeding practice based on pressure to eat. This study showed that feeding problems for children in the ASD sample are a significant problem, and it is still worth exploring this area in research.

Fever-Induced Brugada Sign: Clue for Clinical Management with Non-Negligible Risk of Sudden Cardiac Death.

Brugada syndrome (BrS) is a primary electrical disease predisposing to ventricular tachyarrhythmias and sudden cardiac death [...].