Vitamin D Dietary Supplementation: Relationship with Chronic Heart Failure.

It is estimated that over 1 billion people worldwide have a deficiency of vitamin D, also known as hypovitaminosis D, which the World Health Organization has defined as a public health problem. Beyond its historical homeostasis regulatory function of calcium and phosphorus, in relation to the preservation of the skeletal system, several studies show today a close connection between hypovitaminosis D and the genesis of rheumatic, autoimmune, neoplastic, and cardiovascular diseases. With exclusive reference to cardiovascular aspects, multiple heart diseases such as hypertension, myocardial ischemia, and heart failures might have deficiency in vitamin D as an important causative factor. Because of the influence of concomitant pathologies caused by antibiotic-resistant agents, the function of this vitamin should be critically evaluated. However, the role of vitamin D remains to be established; only a few studies have tested the effects of its supplementation in patients with chronic heart failure diseases, and reported results are unclear. It is important to implement studies in this field in order to assess the real benefits induced by vitamin D supplementation in cardiovascular patients and, in particular, in patients with heart failure. Should the research confirm actual clinical improvement after treatment with vitamin D, such a supplementation might represent a new low-cost therapeutic approach to improving quality of life.

Therapy Of Cardiac Arrhythmias In Children: An Emerging Role Of Electroanatomical Mapping Systems.

INTRODUCTION: Cardiac arrhythmias are challenging diseases in childhood. Most of them in pediatric subjects (90.2%) are atrioventricular reentrant tachycardias and atrioventricular nodal reentrant tachycardias. The standard 12-lead ECG is a highly accurate diagnostic tool but an invasive electrophysiological study is often required. The main concern about this kind of procedures is their invasive nature and the need of radiations, so antiarrhythmic agents are currently the first line therapy. However, they often show side effects and can be insufficient for the rate control. MATERIALS AND METHODS: We performed a systematic research on Embase and PubMed. We found 563 articles and selected the most representative 50. DISCUSSION: Management of cardiac arrhythmias could be very difficult in several scenarios, especially in children with body weight <15 kg and age <4 years. In general, pediatric subjects show a cumulative risk of malignancy greater than adults, having greater life expectancy. On this basis the guiding principle during radiation delivery in electrophysiological procedures is "as low as reasonably achievable" (acronym: ALARA). The development of 3-dimensional (3D) electroanatomical mapping systems allowed significant reduction of exposure. The most recently reported experiences demonstrate safety and feasibility of fluoroless ablation in the most common arrhythmias in children, even in challenging conditions. CONCLUSION: The first reasonable approach in cardiac arrhythmias involving younger patients seems to be pharmacological. However antiarrhythmic drugs pose problems both in terms of side effects and often have poor efficacy. Expertise in electrophysiological techniques is constantly increasing and the development of new technologies allow us to encourage the use of electroanatomical mapping systems in order to reduce the radiation exposure in children undergoing to catheter ablation, especially for accessory pathways.

Rivaroxaban as an effective alternative to warfarin in a patient with atrial fibrillation, thrombophilia, and left atrial appendage thrombus: a case report.

BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia. It is responsible for up to 20% of all ischemic strokes. Rate control and anticoagulation are crucial for atrial fibrillation management and stroke prevention. CASE PRESENTATION: We present the case of an 84-year-old Italian woman with a left atrial appendage thrombus that developed despite her use of anticoagulant therapy with warfarin for a previous pulmonary embolism. She had atrial fibrillation and heterozygosity for both factor V Leiden and methylenetetrahydrofolate reductase C677T mutation, thus creating resistance to activated protein C. Anticoagulant therapy was switched to heparin for 1 week and then to rivaroxaban. After 3 months of rivaroxaban use, the thrombus disappeared. CONCLUSIONS: This case raises the issue of the ineffectiveness of warfarin therapy in complex cases involving particular thrombophilic conditions and the possibility of using rivaroxaban as a safe and effective alternative.