Lead related atrial perforation mimicking inferior ST elevation myocardial infarction.

ST-elevation myocardial infarction (STEMI) is a life-threatening clinical condition that requires immediate intervention, mostly caused by complete occlusion of epicardial vessels. Other diseases such as myocarditis, pericarditis, electrolyte disturbance, and early repolarization may mimic. We present a rare case of atrial lead-related atrial perforation which mimics inferior STEMI.

The predictive value of electrocardiographic polarization parameters on appropriate ICD shock in primary prevention heart failure patients.

OBJECT: The effect of frontal QRS-T angle, Tp-e and Tp-e/QT ratio on cardiac events have been shown in many studies. In this study, we aimed to determine the prognostic value of frontal QRS-T angle, TPe and Tp-e/QT ratio on ICD shock in patients who had ICD (Implantable Cardioverter Defibrillator) implanted due to heart failure with reduced ejection fraction (HFrEF). MATERIAL AND METHOD: 158 patients with HFrEF who had previous ICD implantation were retrospectively analyzed. 27 patients were found to have an appropriate shock. Frontal QRS-T angle, Tp-e interval, Tp-e/QT ratio were calculated by evaluating the basal ECG records of the patients. Comparisons of these arrhythmogenic predictors were made in patients with and without ICD shock at follow-up. RESULT: When 158 patients with previous ICD implantation were analyzed in two groups with and without ICD shock, the number of patients with frontal QRS-T angle >120°, Tp-e interval > 105 ms, Tp-e/QT > 0.2 in the shock group (n: 27) was found to be high with a different significance (p:<0.01, p:<0.01, p:<0.01). There was no significant difference between the two groups regarding other ECG parameters such as QRS duration, QT interval, PR interval, fragmented QRS and positive T wave. In addition, more amiodarone use was observed in the shock group, and more hyperlipidemia cases were observed in the non-shocked group (p:0.01; p:<0.01). CONCLUSION: Increased frontal QRS-T angle, Tp-e interval, and Tp-e/QT ratio are arrhythmogenic parameters and predict appropriate ICD shock.

An unusual 'bow tie' image in pacemaker implantation.

Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.

Comparison of electrophysiological characteristics of right- and left-sided Mahaim-type accessory pathways.

AIMS: Mahaim-type accessory pathways (MAPs) are generally right-sided due to the embryological differentiation, but left-sided localization is also possible. This study aims to compare the clinical and electrophysiological characteristics of right- and left-sided MAPs. METHODS: Of 251 patients diagnosed with AP by electrophysiological study between November 2015 and February 2020, 12 patients with MAP were included (right sided n = 8, left sided n = 4). MAP was diagnosed if; (1) no retrograde conduction; (2) anterograde decremental conduction; (3) adenosine sensitivity; and (4) Mahaim potential at successful ablation site were present. RESULTS: Ten of twelve MAPs were clustered on the lateral walls of the mitral (n = 3, 75%) and tricuspid annuli (n = 7, 87.5%). Right-sided MAPs were mostly long pathways extending toward the conduction system whereas left-sided MAPs were short extending toward the neighboring myocardium. For right- and left-sided APs, the median QRS times were 129 and 156 ms (p = .042), the median VAbl -RVApex intervals were -12 and 64 ms (p = .007), the median QRS-V(His) intervals were 16 and 86 ms (p = .120), and the median VAbl -QRS interval was -8 and 12 ms (p = .017), respectively. Coexistence of dual atrioventricular node physiology was observed only in right-sided APs (n = 3, 37.5%). CONCLUSION: MAPs are more typically located on the right but may rarely be seen on the left. Catheter ablation was associated with high success without complications.

Kinesiophobia and Associated Factors in Patients With Myocardial Infarction.

Kinesiophobia is a well-known barrier to positive clinical outcomes among patients with various diseases, but there remain few comprehensive studies of kinesiophobia among patients with myocardial infarction (MI). In this cross-sectional study, we investigated the presence of kinesiophobia and its relationship with clinical outcomes among 42 patients with MI who completed the Tampa Scale of Kinesiophobia Swedish Version for Heart (TSK-SV Heart) the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Six-Minute Walk Test (6MWT), the Hospital Anxiety and Depression Scale (HADS), the modified Medical Research Council (mMRC) Dyspnea Scale, the Charlson Comorbidity Index (CCI), and the MacNew Heart Disease Health-Related Quality of Life Questionnaire. The participants' mean TSK-SV Heart score was 39.24 (SD = 6.65), and 71.4% of these patients reported a high level of kinesiophobia. The TSK-SV Heart score demonstrated a strong correlation with the IPAQ-SF, 6MWT walking distance, and mMRC score (p < .001), and a moderate correlation with the HADS, CCI, and MacNew Heart Disease HRQoL (p < .05). Patients with a high level of kinesiophobia had lower IPAQ-SF, 6MWT walking distance, and HRQoL and higher mMRC, CCI, and HADS scores than patients with low levels of kinesiophobia (p < .05). Kinesiophobia was common and represented a considerable risk factor for physical-psychosocial dysfunctions in these patients with MI. To maintain functional independence and to increase physical activity level, clinicians should consider kinesiophobia from early to late-stage disease and should add a treatment focus that seeks to eliminate kinesiophobia in cardiac rehabilitation programs.

Effect of home-based high-intensity interval training versus moderate-intensity continuous training in patients with myocardial infarction: a randomized controlled trial.

BACKGROUND: Supervised high-intensity interval training (HIIT) has been proposed to be more effective than moderate-intensity continuous training (MICT) for improving exercise capacity, but there are not sufficient information effects of home-based HIIT and MICT in patients with myocardial infarction (MI). AIMS: To compare the effects of home-based HIIT and MICT in patients with MI. METHODS: Twenty-one patients with MI were randomly assigned to one of two home-based exercise modes: HIIT group and MICT group. Home-based HIIT and MICT were performed twice a week for 12 weeks with an exercise intensity of 85-95% of heart rate (HR) reserve and 70-75% HR reserve, respectively. The primary outcome measure was functional capacity. Secondary outcomes included resting blood pressure and HR, peripheral oxygen saturation, pulmonary function and respiratory muscle strength, dyspnea severity, body composition (body fat%, body mass index (BMI), fat free muscle), peripheral muscle strength, and health-related quality of life (HRQoL). RESULTS: Functional capacity, measured by 6-minute walk test, increased in HIIT and MICT group (p < 0.05). Resting BP and HR, body fat%, and BMI were significantly decreased, and pulmonary functions, respiratory-peripheral muscle strength, and HRQoL were significantly increased in the both groups (p < 0.05). Home-based HIIT was more effective than MICT in improving pulmonary functions and lower extremity muscle strength (p < 0.05). CONCLUSIONS: This study suggests that HIIT and MICT can be applied at home-based in patients with MI and play an important role in improving functional capacity, health outcomes, and HRQoL. TRIAL REGISTRATION: Clinical Trials Number: NCT04407624.

An Effective Novel Index for Predicting the Recurrence of Atrial Fibrillation Ablation: P Wave Duration-to-Amplitude Ratio.

OBJECTIVE: Atrial fibrillation is the most common arrhythmia observed in the clinical practice. Pulmonary vein isolation is a well established treatment option for atrial fibrillation but is limited by recurrence. Previous studies have demonstrated that abnormal P wave indices were associated with adverse atrial remodeling and its role in predicting atrial fibrillation recurrence. In the present study, we aimed to evaluate the place of a novel index as we named P wave duration-to-amplitude ratio in predicting the recurrence of atrial fibrillation. METHODS: Patients who underwent pulmonary vein isolation for symptomatic drug-resistant atrial fibrillation between January 2016 and March 2018 were retrospectively screened. A total of 111 patients were enrolled in the current study. P wave indices of the patients were calculated by precisely measuring the electrocardiogram traces recorded with an electrophysiology recording system. RESULTS: While P wave duration (129 ± 18.4 vs. 109 ± 15.7 ms, P <.001), P wave duration-toamplitude ratio (1072.7 ± 528.3 vs. 626.9 ± 368 ms/mV, P <.001), P wave peak time (65 ± 12 vs. 54 ± 10 ms, P <.001), and P wave dispersion (49 ± 14.1 vs. 27.9 ± 17 ms, P =.001) values were significantly higher in the atrial fibrillation recurrence (+) group, the P wave amplitude (0.12 ± 0.05 vs. 0.18 ± 0.02 mV, P <.001) value was found to be lower. A P wave duration-t o-amplitude ratiovalue of >830 ms/mV has 61.8% sensitivity and 88.4% specificity for the prediction of the atrial fibrillation recurrence (area of under the curve [AUC], 0.727). CONCLUSION: P wave duration-to-amplitude ratio, which may be considered as an indicator of the temporal and electrical propagation of the P wave in the atria, can predict atrial fibrillation ablation recurrence.