The prognostic impact of inflammation in patients with decompensated acute heart failure, as assessed using the pan-immune inflammation value (PIV).

There is increasing evidence that composite scores based on blood counts, which are reflectors of uncontrolled inflammation in the development and progression of heart failure, can be used as prognostic biomarkers in heart failure patients. The prognostic effects of pan-immune inflammation (PIV) as an independent predictor of in-hospital mortality in patients with acute heart failure (AHF) were evaluated based on this evidence. The data of 640 consecutive patients hospitalized for New York Heart Association (NYHA) class 2-3-4 AHF with reduced ejection fraction were analyzed and 565 patients were included after exclusion. The primary outcome was in hospital all-cause death. Secondary outcomes were defined as the following in-hospital events: Acute kidney injury (AKI), malignant arrhythmias, acute renal failure (ARF) and stroke. The PIV was computed using hemogram parameters such as lymphocytes, neutrophils, monocytes and platelets. Patients were categorized as low or high PIV group according to the median value, which was 382.8. A total of 81 (14.3%) in-hospital deaths, 31 (5.4%) AKI, 34 (6%) malignant arrhythmias, 60 (10.6%) ARF and 11 (2%) strokes were reported. Patients with high PIV had a higher in-hospital mortality rate than patients with low PIV (OR: 1.51, 95% CI, 1.26-1.80, p < 0.001). Incorporating PIV into the full model significantly improved model performance (odds ratio X2, p < 0.001) compared to the baseline model constructed with other inflammatory markers. PIV is a potent predictor of prognosis with better performance than other well-known inflammatory markers for patients with AHF.

Left Ventricular Mass Index Predicts Pacemaker-Induced Cardiomyopathy in Patients with Dual Chamber Permanent Pacemakers Implanted Due to Complete Atrioventricular Block.

Background: Pacing-induced cardiomyopathy (PICM) occurs as a result of high-burden right ventricular (RV) pacing, which usually develops in patients with complete atrioventricular (AV) block. There is a paucity of data on the association between PICM and pre-implantation left ventricular mass index (LVMI). Thus, the purpose of this study was to analyze the influence of LVMI on PICM in patients who had dual chamber permanent pacemakers (PPMs) implanted secondary to complete AV block. Methods: Overall, 577 patients with dual chamber permanent pacemakers (PPMs) were classified into three tertiles according to their pre- implantation LVMI. The average follow-up period was 57 ± 38 months. The baseline characteristics, laboratory and echocardiographic variables were compared between the tertiles. PICM was defined as a ≥ 10% drop in left ventricular ejection fraction (LVEF) from pre-implantation with a resultant LVEF < 50%. PICM occurred in 42 (7.2%) patients. The independent predictors of PICM development, as well as the impact of LVMI on PICM, were investigated. Results: After controlling for confounding baseline variables, the tertile with the greatest LVMI had a 1.8 times higher risk for the development of long-term PICM compared with the tertile with the lowest LVMI, which was accepted as the reference group. A receiver operating characteristic curve analysis revealed that the best LVMI cut- off value for predicting long-term PICM was 109.8 g/m2 with 71% sensitivity and 62% specificity (area under curve: 0.68; 95% confidence interval: 0.60-0.76; p < 0.001). Conclusions: This investigation revealed that pre-implantation LVMI had a prognostic role in predicting PICM in patients with an implanted dual chamber PPM due to complete AV block.

Evaluating systemic immune-inflammation index in patients with implantable cardioverter defibrillator for heart failure with reduced ejection fraction.

BACKGROUND: Pro-inflammatory pathways play an important role in the follow-ups of patients with intracardiac defibrillators (ICDs) for heart failure (HF) reduced with ejection fraction (HFrEF). A newly defined index - the systemic immune-inflammation index (SII)-has recently been reported to have prognostic value in patients with cardiovascular disease. This study's aim is to evaluate the SII value regarding its association with long-term mortality and appropriate ICD therapy during a 10-year follow-up. METHODS: This retrospective study included 1011 patients with ICD for HFrEF. The SII was calculated as the neutrophil-to-lymphocyte ratio × total platelet count in the peripheral blood. The study population was divided into two groups according to the SII's optimal cut-off value to predict long-term mortality. The long-term prognostic impact of SII on these patients was evaluated regarding mortality and appropriate ICD therapy. RESULTS: The patients with a higher SII (≥1119) had significantly higher long-term mortality and appropriate ICD therapy rates. After adjustment for all confounding factors, the long-term mortality rate was 5.1 for a higher SII. (95% CI: 2.9-8.1). The long-term appropriate ICD therapy rate was 2.0 for a higher SII (95% CI: 1.4-3.0). CONCLUSION: SII may be an independent predictive marker for both long-term mortality and appropriate ICD therapy in patients with HFrEF.

Cardiac variables associated with atrial fibrillation occurrence and mortality in octogenarians implanted with dual chamber permanent pacemakers.

BACKGROUND: There is a dearth of data on the predictors of atrial fibrillation (AF) and the association between AF and long-term mortality in octogenarians with dual-chamber permanent pacemakers (PPM). We investigate the occurrence of AF and whether it is associated with overall mortality among octogenarians with dual-chamber PPM implants. METHODS: Three hundred and fifty-four patients with PPM implants were divided into two groups based on their long-term survival status. Baseline characteristics, laboratory variables, and echocardiographic variables were then compared between the groups, and independent predictors of the long-term incidence of AF and mortality were determined. RESULTS: Multivariable Cox regression analysis performed after adjusting for the parameters in univariable analysis revealed that diabetes, urea levels, albumin levels, paced QRS duration, and the frequency of atrial high-rate episodes (AHREs) were independently associated with a long-term risk of AF in octogenarians after having dual chamber PPMs implanted. The left ventricular (LV) ejection fraction, left atrial (LA) anteroposterior diameter, and AHRE + AF (HR 1.498, 95%CI 1.003-2.237, p = 0.048) were independent risk factors for the long-term mortality in octogenarians receiving dual-chamber PPMs implants. CONCLUSION: The occurrence of AF following dual-chamber PPM implantation is a significant prognostic factor in octogenarian patients.

Comparison of mortality prediction scores in elderly patients with ICD for heart failure with reduced ejection fraction.

BACKGROUND: This investigation aimed to examine and compare the predictive value of MADIT-II, FADES, PACE and SHOCKED scores in predicting one-year and long-term all-cause mortality in implantable cardioverter-defibrillator (ICD) implanted patients, 75 years old and older, since there has been an area of uncertainty about the utility and usefulness of these available risk scores in such cases. METHODS: In this observational, retrospective study, 189 ICD implanted geriatric patients were divided into two groups according to the presence of long-term mortality in follow-up. The baseline characteristics and laboratory variables were compared between the groups. MADIT-II, FADES, PACE and SHOCKED scores were calculated at the time of ICD implantation. One-year and long-term predictive values of these scores were compared by a receiver-operating curve (ROC) analysis. RESULTS: A ROC analysis showed that the best cutoff value of the MADIT-II score to predict one-year mortality was ≥ 3 with 87% sensitivity and 74% specificity (AUC 0.83; 95% CI 0.73-0.94; p < 0.001) and that for long-term mortality was ≥ 2 with 83% sensitivity and 43% specificity (AUC 0.68; 95% CI 0.60-0.76; p < 0.001). The predictive value of MADIT-II was superior to FADES, PACE and SHOCKED scores in ICD implanted patients who are 75 years and older. CONCLUSION: MADIT-II score has a significant prognostic value as compared to FADES, PACE and SHOCKED scores for the prediction of one-year and long-term follow-up in geriatric patients with implanted ICDs for heart failure with reduced ejection fraction.

The use of ivabradine in a patient with idiopathic ventricular arrhythmia originating from the left ventricular summit.

Idiopathic ventricular arrhythmias (VA) are common and treatment options include anti-arrhythmic drugs (AAD) or catheter ablation. Patients presenting with idiopathic VA which is originating from the left ventricular summit (LVS) poses a particular challenge as the success for catheter ablation is low and AAD's may not be used long-term due to side effects. Ivabradine is an inhibitor of funny current (If) in cardiac pacemaker cells by blocking hyperpolarization-activated cyclic nucleotide-gated (HCN). In the present case, we reported the use of ivabradine in treatment of idiopathic VA which was originated from LVS and was resistant to multiple AAD's and catheter ablation.

The value of C-reactive protein-to-albumin ratio in predicting long-term mortality among HFrEF patients with implantable cardiac defibrillators.

BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) who received implantable cardiac defibrillator (ICD) still remain at high risk due to pump failure and prevalent comorbid conditions. The primary aim of this research was to evaluate the predictive value of C-reactive protein-to-albumin ratio (CAR) for all-cause mortality among patients with HFrEF despite ICD implantation. MATERIALS AND METHODS: Those who were implanted ICD for HFrEF in our institution between 2009 and 2019 were included. Data were extracted from hospital's database. CAR was calculated as ratio of C-reactive protein (CRP) to serum albumin concentration. Patients were grouped into tertiles in accordance with CAR at the time of the implantation. During follow-up duration of 38 [17-77] months, survival times of tertiles were compared by using Kaplan-Meier survival method. Forward Cox proportional regression model was used for multivariable analysis. RESULTS: Thousand and eleven patients constituted the study population. Ischaemic cardiomyopathy was the primary diagnosis in 92.3%, and ICD was implanted for the primary prevention among 33.9% of patients. Of those, 14.5% died after the discharge. Patients in tertile 3 (T3) had higher risk of mortality (4.2% vs 11.0% vs 28.5%) compared with those in other tertiles. Multivariable analysis revealed that when patients in T1 were considered as the reference, both those in T2 and those in T3 had independently higher risk of all-cause mortality. This finding was consistent in the unadjusted and adjusted multivariable models. CONCLUSION: Among patients with HFrEF and ICD, elevated CAR increased the risk of all-cause mortality at long term.

Prognostic nutritional index as the predictor of long-term mortality among HFrEF patients with ICD.

BACKGROUND: The benefit of implantable cardiac defibrillator (ICD) in patients with heart failure and reduced ejection fraction (HFrEF) could be limited in a particular group of patients. Low prognostic nutritional index (PNI) indicates malnutrition and proinflammatory condition. We sought to investigate the value of PNI in predicting long-term mortality among HFrEF patients with ICD. METHODS: Electronic database was searched for identifying patients with HFrEF who were implanted ICD in our institution between 2009 and 2019. Demographic and clinical characteristics of included patients were recorded. PNI was calculated according to the formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3 ). Patients were divided into the quartiles according to PNI values. Differences between the groups were analyzed by the log-rank test. A forward Cox proportional regression model was used for multivariable analysis. RESULTS: One thousand and hundred patients were included to the study. The underlying heart failure etiology was ischemic and nonischemic in 77.3% and 22.7% of patients, respectively. Mortality rate in Q1 (5.1%) was considered as the reference. In the unadjusted model the mortality rate was 9.5% (hazard ratio [HR] 1.76, 95% confidence interval [95% CI] [0.92-3.38]) in Q2, 10.2% (HR 1.88, 95% CI 0.99-3.58) in Q3, and 39.6% (HR 8.12, 95% CI 4.65-14.17) in Q4. The same trend was consistent in the age- and sex-adjusted, comorbidities-adjusted, and covariates-adjusted models. CONCLUSION: Among patients who were implanted with ICD secondary to HFrEF, lower PNI value predicted all-cause mortality during long-term follow-up. This is the first study demonstrating the value of PNI in this population.

Management of heart failure with concomitant complete atrioventricular block caused by a novel missense LMNA mutation.

A 30-year-old lady was admitted to the hospital with progressive exertional dyspnoea and bradycardia. A complete atrioventricular block was diagnosed using 12­lead electrocardiography and a transthoracic echocardiography revealed a severely impaired left ventricular systolic dysfunction with an ejection fraction of 20%. Following hospitalization, her coronary angiography was normal, so a whole exome sequencing was conducted. The novel Lamin A/C Gene missense mutation c.263C > A,p.Ala88Asp in exon 3 was identified. A CRT-D was implanted due to the high risk of life-threatening ventricular arrhythmias and low potential for left ventricular reverse remodelling. The patient is undergoing follow-ups at the outpatient clinic, showing a 25% improvement in left ventricular ejection fraction during the last visit.

Increased epicardial fat tissue thickness predicts advanced interatrial block among hypertensive patients.

BACKGROUND: Recent studies demonstrated that epicardial fat tissue (EFT) was associated with prevalent AF and recurrences following the catheter ablation. We evaluated the value of EFT for the prediction of advanced interatrial block (a-IAB) in the surface electrocardiography (ECG) among hypertensive patients. METHODS: Patients with prior diagnosis of hypertension (HT) were included in the study. Surface ECG and transthoracic echocardiography (TTE) were performed to each patient. A-IAB was defined as P-wave duration longer than 120 ms with biphasic morphology in the inferior leads. EFT was identified by using TTE and was measured perpendicularly in front of the right ventricular free wall at the end-systole. RESULTS: Between February 2019 and February 2020 245 patients met the eligibility criteria. A-IAB was found among 35 patients and compared to those without IAB, they had increased waist circumference, elevated left ventricular mass index (LVMI) and left atrial volume index (LAVI), lower LDL and increased P wave duration. EFT thickness was higher in patients with a-IAB compared to those without (5.3 ±â€¯2.2 mm vs 7.6 ±â€¯2.4 mm). Multivariable analysis revealed that increased EFT thickness and lower LDL level predicted a-IAB. CONCLUSION: Among patients with prior diagnosis of HT, higher EFT thickness evaluated by TTE predicted the presence of a-IAB on the surface ECG.

In-Hospital Prognostic Value of Electrocardiographic Parameters Other Than ST-Segment Changes in Acute Myocardial Infarction: Literature Review and Future Perspectives.

Electrocardiography (ECG) remains an irreplaceable tool in the management of the patients with myocardial infarction, with evaluation of the QRS and ST segment being the present major focus. Several ECG parameters have already been proposed to have prognostic value with regard to both in-hospital and long-term follow-up of patients. In this review, we discuss various ECG parameters other than ST segment changes, particularly with regard to their in-hospital prognostic importance. Our review not only evaluates the prognostic segments and parts of ECG, but also highlights the need for an integrative approach in big data to re-assess the parameters reported to predict in-hospital prognosis. The evolving importance of artificial intelligence in evaluation of ECG, particularly with regard to predicting prognosis, and the potential integration with other patient characteristics to predict prognosis, are discussed.

Association of the CHA2DS2VASc Score with Acute Stent Thrombosis in Patients with an ST Elevation Myocardial Infarction Who Underwent a Primary Percutaneous Coronary Intervention.

OBJECTIVE: In this study, we aimed to determine the predictive value of the CHA2DS2VASc score for acute stent thrombosis in patients with an ST elevation myocardial infarction treated with a primary percutaneous coronary intervention (pPCI). METHODS: This was a retrospective study conducted among 3,460 consecutive patients with STEMI who underwent a pPCI. The stent thrombosis was considered a definite or confirmed event in the presence of symptoms suggestive of acute coronary syndrome and angiographic confirmation of stent thrombosis based on the diagnostic guidelines of the Academic Research Consortium. The stent thrombosis was classified as acute if it developed within 24 h. RESULTS: The mean CHA2DS2VASc score was 3.29 ± 1.73 in the stent thrombosis group, whereas it was 2.06 ± 1.14 in the control group (p < 0.001). In multivariable logistic regression analysis, CHA2DS2VASc scores ≥ 4 were independently associat ed with acute stent thrombosis (OR = 1.64; 95% CI 1.54-1.71, p < 0.001). In a receiver operating characteristic curve ana-lysis, the best cut-off value for the CHA2DS2VASc score was ≥4, with 60% sensitivity and 73% specificity. Of note, pa tients with a CHA2DS2VASc score of 4 had a 4.3 times higher risk of acute stent thrombosis compared to those with a CHA2DS2VASc score of 1. CONCLUSIONS: The CHA2DS2VASc score may be a significant independent predictor of acute stent thrombosis in patients with STEMI treated with a pPCI. Therefore, the CHA2DS2VASc score may be used to assess the risk of acute stent thrombosis in patients with STEMI following a pPCI.

ST Depression, No ST Change, or ST Elevation in Inferior Derivations: Which Has the Worst Outcomes in Acute Anterior Myocardial Infarction?

OBJECTIVE: The combination of electrical phenomena and remote myocardial ischemia is the pathophysiological mechanism of ST segment changes in inferior leads in acute anterior myocardial infarction (MI). We investigated the prognostic value of ST segment changes in inferior derivations in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PCI). METHODS: In this prospective single-center analysis, we evaluated the prognostic impact of ST segment changes in inferior derivations on 354 patients with acute anterior MI. Patients were divided into the following 3 groups according to admission ST segment changes in inferior derivations: ST depression (group 1), no ST change (group 2), and ST elevation (group 3). RESULTS: In-hospital multivariate analysis revealed notably high rates of in-hospital death for patients in group 3 compared to patients in group 2 (OR 2.5; 95% CI 1.6-7.6, p < 0.001). Group 1 and group 2 had similar in-hospital and long-term mortality rates. After adjusting for confounding baseline variables, group 3 had higher rates of 18-month mortality (HR 3.3; 95% CI 1.5-8.2, p < 0.001). CONCLUSION: In patients with a first acute anterior MI treated with primary PCI, ST elevation in inferior leads had significantly worse short-term and long-term outcomes compared to no ST change or ST segment depression.

The prognostic significance of early and late right precordial lead (V4 R) ST-segment elevation in patients with acute anterior myocardial infarction.

BACKGROUND: The predictive significance of ST-segment elevation (STE) in lead V4 R in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been well-understood. In this study, we evaluated the prognostic value of early and late STE in lead V4 R in patients with anterior STEMI. METHODS: A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V4 R at admission and/or 60 min after PPCI. Based on this classification, all patients were divided into three subgroups as no V4 R STE (Group 1), early but not late V4 R STE (Group 2) and late V4 R STE (Group 3). RESULTS: In-hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1-times higher mortality than group 1. Late V4 R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9-4.3; p < .001) and in-hospital mortality (OR 2.3; 95% CI 1.8-4.1; p < .001). The 12-month overall survival for group 1, 2, and 3 were 91.1%, 82.4%, and 71.4% respectively. However, the long-term mortality also had the higher rate at group 3; late V4 R STE did not remain as an independent risk factor for long-term mortality (OR 1.5; 95% CI 0.8-4.1; p: .159). CONCLUSION: Late V4 R STE in patients with anterior STEMI is strongly associated with poor prognosis. The record of late V4 R in patients with anterior STEMI has an important prognostic value.

A tale of two formulas: Differentiation of subtle anterior MI from benign ST segment elevation.

BACKGROUND: It may sometimes be difficult to differentiate subtle ST-segment elevation (STE) due to anterior myocardial infarction (MI) from benign variant (BV) STE. Recently, two related formulas were proposed for this purpose. However, they have never been tested in an external population. MATERIALS AND METHODS: Consecutive patients from May 2017 to January 2018, who were admitted with the diagnosis of acute anterior STEMI, were enrolled. Electrocardiograms were systematically reviewed and only subtle ones were included. First 200 consecutive patients with noncardiac chest pain were also enrolled as a control group. Relevant electrocardiographic parameters were measured. RESULTS: A total of 379 anterior MI and 200 BV-STE cases were enrolled during study period. A total of 241 patients in STEMI group were excluded for not matching subtleness criteria, four patients in control group were also excluded because of prior left-anterior descending artery intervention. The three-variable formula, with recommended cut-point of 23.5, had a sensitivity, specificity, and diagnostic accuracy of 73.9%, 86.7%, and 81.4%, respectively. The four-variable formula, with the published cut-point of 18.2, had a sensitivity, specificity, and diagnostic accuracy of 83.3%, 87.7%, and 85.9%, respectively. CONCLUSION: Three- and four-variable formulas with recommended cutoffs have a reasonable sensitivity, specificity, and diagnostic accuracy in differentiating subtle STEMI with BV-STE. Although both perform well, the four-variable formula has a higher sensitivity, specificity, and diagnostic accuracy and should be preferred.

What is the predictive value of ST segment depression in inferior leads in first acute anterior myocardial infarction?

BACKGROUND: Electrical phenomenon and remote myocardial ischemia are the main factors of ST segment depression in inferior leads in acute anterior myocardial infarction (AAMI). We investigated the prognostic value of the sum of ST segment depression amplitudes in inferior leads in patients with first AAMI treated with primary percutaneous coronary intervention. (PPCI). METHODS: In this prospective analysis, we evaluated the in-hospital prognostic impact of the sum of ST segment depression in inferior leads on 206 patients with first AAMI. Patients were stratified by tertiles of the sum of admission ST segment depression in inferior leads. Clinical outcomes were compared between those tertiles. RESULTS: Univariate analysis revealed higher rate of in-hospital death for patients with ST segment depression in inferior leads in tertile 3, as compared to patients in tertile 1 (OR 9.8, 95% CI 1.5-78.2, p<0.001). After adjustment for baseline variables, ST segment depression in inferior leads in tertile 3 was associated with 5.7-fold hazard of in-hospital death (OR: 5.7, 95% CI 1.2-35.1, p<0.001). Spearman rank correlation test revealed correlation between the sum of ST segment depression amplitude in inferior leads and the sum of ST segment elevation amplitude in V1-6, L1 and aVL. Multivessel disease and additional RCA stenosis were also detected more often in tertile 3. CONCLUSION: The sum of ST segment depression amplitude in inferior leads of admission ECG in patients with first AAMI treated with PPCI provide an independent prognostic marker of in-hospital outcomes. Our data suggest the sum of ST segment depression amplitude to be a simple, feasible and clinically applicable tool for rapid risk stratification in patients with first AAMI.

Which admission electrocardiographic parameter is more powerful predictor of no-reflow in patients with acute anterior myocardial infarction who underwent primary percutaneous intervention?

BACKGROUND: Acute transmural ischemia due to left anterior descending artery (LAD) occlusion changes precordial R and Q wave durations owing to depressed intramyocardial activation. We investigated the prognostic value of sum of precordial Q wave duration/sum of precordial R wave duration ratio (Q/R) in patients with first acute anterior myocardial infarction (AAMI) treated with primary percutaneous coronary intervention (PPCI). METHODS: In this prospective analysis, we evaluated the no-reflow predictive value of Q/R on 403 patients with first AAMI. Patients were divided into two as no-reflow group (n=32) and control (n=371) group according to post-PPCI flow status. RESULTS: The patients in the no-reflow group had significantly higher Q/R on admission electrocardiography (ECG) compared to patients in the control group (p<0.001). When admission ECG parameters were compared according to no-reflow prediction, Q/R was stronger than other well-accepted parameters. The best cut-off value of the Q/R to predict no-reflow was 1.08 with 76% sensitivity and 73% specificity (AUC: 0.78; 95% CI: 0.72-0.83; p<0.001). CONCLUSION: In patients with first AAMI treated with PPCI, Q/R in admission ECG may have a role as an independent predictive marker of no-reflow.

A simple independent prognostic electrocardiography parameter in first acute anterior myocardial infarction; Precordial total Q wave/precordial total R wave.

BACKGROUND: We investigated the prognostic value of precordial total Q wave amplitude/precordial total R wave amplitude ratio (Q/R) in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PPCI). METHODS: We evaluated the in-hospital prognostic impact of Q/R on 354 patients with first acute anterior MI. Patients were stratified by tertiles of admission Q/R, clinical outcomes were compared between those groups. RESULTS: In-hospital univariate analysis revealed notably higher rates of in-hospital death for patients in tertile 3, as compared to patients in tertile 1 (OR 9.7, 95% CI 2.8-33.5, p. CONCLUSION: Q/R in admission ECG in patients with first acute anterior MI provide an independent prognostic marker of in-hospital outcomes.

Interatrial block predicts atrial high rate episodes detected by cardiac implantable electronic devices.

BACKGROUND: Interatrial block which is defined as P wave duration longer than 120 milliseconds is underappreciated but highly prevalent electrocardiographic abnormality and associated with atrial tachyarrhythmias and ischemic stroke. Impaired left atrial mechanics and atrial fibrillation are potential mechanisms contributing to the embolic events associated with interatrial block. Detection of atrial high rate episodes by cardiac implantable electronic devices provides clinicians to diagnose asymptomatic atrial fibrillation. The relation between interatrial block and asymptomatic atrial fibrillation can provide an insight to the increased risk of ischemic stroke in patients with interatrial block. METHODS: We prospectively evaluated 367 patients who were implanted dual chamber pacemaker due to sinus node dysfunction (SND) between January 2015 and December 2015. Twelve lead electrocardiograms were analyzed to diagnose interatrial block before pacemaker implantation. Six months after the implantation, pacemakers were interrogated to detect atrial high rate episodes. Patients were divided into two groups in terms of presence or absence of atrial high rate episodes. RESULTS: Atrial high rate episodes were detected in 107 (30.1%) patients during their device interrogation. Interatrial block was found in 115 (32.4%) patients out of total study population. Sixty-seven (27.0%) patients in AHRE (-) group had interatrial block while 48 (44.9%) patients had in AHRE (+) group. Prevalence of interatrial block was statistically significantly higher in AHRE (+) patients (P<0.01). CONCLUSION: Occurrence of atrial high rate episodes, a surrogate for asymptomatic atrial fibrillation, is statistically significantly higher in patients with interatrial block.

Long-Term Antiarrhythmic Effects of Thrombolytic Therapy in Pulmonary Embolism.

BACKGROUND: The role of thrombolytic therapy in acute pulmonary embolism patients is still controversial considering the occurrence of arrhythmias. Short-term effects of thrombolytics are well-known whereas long-term effects on cardiac electrophysiology have not been reported before. The objective of our study was to assess the arrhythmic differences in pulmonary embolism patients who received thrombolytics followed by anticoagulation or anticoagulation alone. METHODS: Sixty patients who received thrombolytic therapy followed by anticoagulation (group 1) and 60 patients who received anticoagulation alone (group 2) were included in this retrospective, single-centre observational study. Twenty-four-hour ambulatory electrocardiography was performed 31 ± 9 months after pulmonary embolism hospitalisation in order to compare arrhythmias originating from both ventricles and atria. RESULTS: The age and gender distribution of the patients were statistically similar. Ventricular arrhythmias were found to be the same between t-PA and non t-PA groups. All types of atrial arrhythmias were found to be increased in non t-PA group even though left and right atrial volume indexes were statistically identical between the two groups. CONCLUSION: In long-term pulmonary embolism, follow-up thrombolytic therapy was demonstrated to have atrial antiarrhythmic effects.