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BACKGROUND: Brugada syndrome (BrS) is characterized by ST-segment elevation in the right precordial leads, which is not explained by ischemia, electrolyte disturbances, or obvious structural heart disease. AIM: In present study, we aim to evaluate presentation, long-term outcome, genetic findings, and therapeutic interventions in patients with BrS. METHODS: Between September 2001 and June 2022, all consecutive patients with diagnosis of BrS were enrolled in the present study. All patients gave written informed consent for the procedure, and the local ethical committee approved the study. RESULTS: Of the 76 cases, 79% were proband and 21% were detected during screening after diagnosis of BrS in a family member. Thirty-three (43%) patients had a typical spontaneous electrocardiogram (ECG) pattern. Thirty percent of the patients were symptomatic; symptomatic patients were more likely to have spontaneous type 1 Brugada ECG pattern in their ECGs (p = .01), longer PR interval (p = .03), and SCN5A mutation (p = .01) than asymptomatic patients. The mean PR interval was considerably longer in men than women (p = .034). SCN5A mutation was found in 9 out of 50 (18%) studied patients. Fifteen percent received appropriate implantable cardioverter-defibrillator (ICD) therapy and inappropriate ICD interventions were observed in 17%. Presentation with aborted SCD or arrhythmic syncope was the only predictor of adverse outcome in follow-up (odds ratio: 3.1, 95% confidence interval: 0.7-19.6, p = .001). CONCLUSIONS: Symptomatic patients with BrS are more likely to present with spontaneous type 1 Brugada ECG pattern, longer PR interval, and pathogenic mutation in SCN5A gene. Appropriate ICD interventions are more likely in symptomatic patients and those with SCN5A mutation.
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Síndrome de Brugada , Desfibriladores Implantáveis , Masculino , Humanos , Feminino , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/genética , Síndrome de Brugada/terapia , Estudos Longitudinais , Irã (Geográfico) , Eletrocardiografia/métodosRESUMO
BACKGROUND: Postoperative atrial fibrillation (POAF) is one of the most common types of acute AF and can complicate the treatment course of approximately one third of patients undergoing cardiac surgery. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are among the newest antidiabetic drugs which can be therapeutic options for preventing POAF by different mechanisms. METHODS: Empagliflozin to Prevent POAF (EMPOAF) is an interventional, investigator-initiated, double-blind, placebo-controlled, multicenter, randomized controlled trial which will be conducted in two referral teaching cardiology hospitals in Tehran. Four-hundred ninety-two adult patients who are scheduled for elective isolated coronary artery bypass graft (CABG) surgery will be randomly assigned to one of the groups of intervention (empagliflozin 10 mg daily) or placebo starting at least 3 days before surgery until discharge. Key exclusion criteria are a history of diabetes mellitus, AF, ketoacidosis, or recurrent urinary tract infections along with severe renal or hepatic impairment, unstable hemodynamics, and patients receiving SGLT2 inhibitors for another indication. The primary outcome will be the incidence of POAF. Key secondary endpoints will be the composite rate of life-threatening arrhythmias, postoperative acute kidney injury, hospitalization length, in-hospital mortality, stroke, and systemic embolization. Key safety endpoints will be the rate of life-threatening and/or genitourinary tract infections, hypoglycemia, and ketoacidosis. CONCLUSIONS: EMPOAF will prospectively evaluate whether empagliflozin 10 mg daily can reduce the rate of POAF in patients undergoing elective CABG. Enrolment into this study has started by November 2023 and is expected to be ended before the end of 2025.
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Fibrilação Atrial , Compostos Benzidrílicos , Ponte de Artéria Coronária , Glucosídeos , Complicações Pós-Operatórias , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Glucosídeos/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Fibrilação Atrial/prevenção & controle , Compostos Benzidrílicos/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Método Duplo-Cego , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
INTRODUCTION: Epicardial pacemakers are known as an alternative for endocardial pacemakers in some cases such as heart block, and complex congenital heart diseases. Considering recent advances and improvement of epicardial lead subtypes, it is essential to investigate the long-term function of them. In this study, we aimed to assess the sensing and pacing characteristics, and survival of bipolar steroid-eluting and unipolar nonsteroid-eluting epicardial pacemakers. METHODS: We conducted an entirely concentrated search on the documents of all patients who had undergone epicardial lead implantation in the Shaheed Rajaie Cardiovascular, Medical & Research Center during 2015-2018. Implant, and follow-up data were extracted. Kaplan-Meier analysis and Weibull regression hazards model were applied for the survival analysis. RESULTS: Eighty-nine leads were implanted for 77 patients. Of the total leads, 52.81%, 53.93%, and 47.19% were implanted in children (under 18-year-old), females, and patients with congenital heart diseases, respectively. Bipolar steroid-eluting leads comprised 33.71% of 89 leads. The pacing threshold of unipolar nonsteroid-eluting leads that were implanted on the left ventricle and right atrium increased significantly during the follow-up to greater records than bipolar steroid-eluting leads. Survival analysis also revealed that bipolar steroid-eluting leads are significantly better in 48-month survival (Weibull hazard ratio [HR]: 0.13 (95% confidence interval [CI]: 0.02-0.99), p = .049). Age, ventricular location of the lead, and acute pacing characteristics were not associated with survival. CONCLUSIONS: Bipolar steroid-eluting epicardial leads have an acceptable survival compared with unipolar nonsteroid-eluting, without a significant difference regarding patients age. Therefore, they could be an excellent alternative for endocardial ones.
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Cardiopatias Congênitas , Marca-Passo Artificial , Criança , Feminino , Humanos , Adolescente , Átrios do Coração , Ventrículos do Coração , Análise de Sobrevida , Eletrodos Implantados , Estimulação Cardíaca Artificial , SeguimentosRESUMO
BACKGROUND: The subcutaneous implantable-defibrillator (S-ICD) is a relatively new alternative to the transvenous ICD system to minimize intravascular lead-related complications. This paper presents outcome of SICD implantation in patients enrolled in Iran S-ICD registry. METHODS: Between October 2015 and June 2022, this prospective multicenter national registry included 223 patients with a standard indication for an ICD, who neither required bradycardia pacing nor needed cardiac resynchronization to evaluate the early post-implant complications and long-term follow-up results of the S-ICD system. RESULTS: The mean age of the patients was 45 ± 17 years. The majority (79.4%) were male. Ischemic cardiomyopathy (39.5%) was the most common underlying disorder among patients selected for S-ICD implant. Most study patients (68.6%) had ICD for primary prevention of sudden cardiac death. Seven patients (3.1%) were found to have suboptimal lead positions. Six patients (2.7%) developed a pocket hematoma; all were managed medically. During a mean follow-up of 2 years, the appropriate therapy was recorded in 13% of the patients and inappropriate ICD intervention mainly due to supraventricular tachycardia in 8.9%. Pocket infection was observed in four patients (1.8%) and five patients (2.2%) died mainly due to heart failure. CONCLUSION: S-ICDs were effective at detecting and treating both induced and spontaneous ventricular arrhythmias. Major clinical complications were rare.
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Desfibriladores Implantáveis , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudos Prospectivos , Irã (Geográfico) , Resultado do Tratamento , Desfibriladores Implantáveis/efeitos adversos , Morte Súbita Cardíaca/prevenção & controle , Morte Súbita Cardíaca/etiologia , Sistema de RegistrosRESUMO
Atrial fibrillation (AF) is a morbid and heritable irregular cardiac rhythm that affects about 2%-3% of the population. Patients with early-onset AF have a strong genetic association with the disease; nonetheless, the exact underlying mechanisms need clarification. We herein present our evaluation of a 2-generation Iranian pedigree with early-onset AF. Whole-exome sequencing was applied to elucidate the genetic predisposition. Direct DNA sequencing was utilized to confirm and screen the variants in the proband and his available family members. The pathogenicity of the identified nucleotide variations was scrutinized via either segregation analysis in the family or in silico predictive software. The comprehensive variant analysis revealed a missense variant (c.G681C, p.E227D, rs1477078144) in the human α-dystrobrevin gene (DTNA), which is rare in genetic databases. Most in silico analyses have predicted this variant as a disease-causing variant, and the variant is co-segregated with the disease phenotype in the family. Previous studies have demonstrated the association between the DTNA gene and left ventricular noncompaction cardiomyopathy. Taken together, we provide the first evidence of an association between a nucleotide variation in the DTNA gene and early-onset AF in an Iranian family. However, the genetic testing of AF in the Iranian population is still limited. This finding not only further confirms the significant role of genetics in the incidence of early-onset AF but also expands the spectrum of the gene variations that lead to AF. Additionally, it may have further implications for the treatment and prevention of AF.
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Fibrilação Atrial/genética , Análise Mutacional de DNA , Proteínas Associadas à Distrofina/genética , Sequenciamento do Exoma , Frequência Cardíaca/genética , Mutação de Sentido Incorreto , Neuropeptídeos/genética , Adolescente , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Eletrocardiografia , Feminino , Predisposição Genética para Doença , Hereditariedade , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Linhagem , Fenótipo , Valor Preditivo dos Testes , Adulto JovemRESUMO
Background: Low- and middle-income (LMICs) countries are facing with a high incidence of cardiovascular diseases and limited resources for confronting these diseases. Atrial fibrillation(AF) is the most common cardiac arrhythmia in the world that is associated with significant morbidity and mortality. This study assessed cost-effectiveness studies of novel oral anticoagulants(NOACs) compared to Warfarin for the prevention of stroke in patients with AF in LMICs. Methods: In this systematic review study, electronic databases were searched for economic evaluation studies about NOACs cost-effectiveness conducted in LMICs between 2008 and 2019. The selection of studies for review was also based on the PICO (population, intervention, comparison, and outcomes) guidelines. In this study, the population was restricted to patients with atrial fibrillation living in LMICs. We identified three types of drugs (apixaban, rivaroxaban, dabigatran, and edoxaban) as interventions and warfarin as the comparison therapy. Quality of Health Economic Studies checklist was used to evaluate the quality of the included articles. Results: Sixteen articles were extracted, including four cost-effectiveness analyses and two cost-utility analyses. QHES scores ranged from 58 to 87.5 out of a possible 100 points, with a mean score of 77.34. The results of the study showed that from a social perspective, Edoxaban is the most cost-effective therapeutic option compared to warfarin and other NOACs, but Warfarin was much more cost-effective than Rivaroxaban and Apixaban. Furthermore, NOACs were more cost-effective than warfarin from the payer perspective, but from the health system perspective, all NOACs were dominated by warfarin. Conclusion: The present systematic review demonstrates that from a social perspective, Edoxaban is the optimal alternative to warfarin other NOACs for stroke prevention in patients with AF in (LMICs). one study was found on the economic evaluation of NOACs and warfarin in patients with AF in low-income countries, so further research on the economic evaluation of these drugs is recommended.
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BACKGROUND: Atrial fibrillation. (AF) is the most common sustained arrhythmia globally and its prevalence is likely to increase in the next decades as a result of increasing age and co-morbidities. There are no data on demographic features, clinical characteristics, associated comorbidities, and practice patterns of AF in Iran. METHODS: The Iranian Registry of Atrial Fibrillation (IRAF) is a hospital-based prospective survey of AF patients with a 12-month follow-up. Data were collected on a standardized case report form and entered into a web-based electronic database. This paper reports the baseline characteristics of the IRAF cohort. RESULTS: Between February 2018 and March 2020, a total of 1300 patients (57% Male, mean age, 60 ± 14 years) were enrolled. Palpitations were the most common presenting symptom (66%). The most common cardiac comorbidities were hypertension (52%), heart failure (23.7%), and valvular heart disease (21.8%). AF mainly presented as a paroxysmal pattern (44.6%). Seventy-eight percent of the patients with non-valvular AF had CHA2 DS2 -VASc score ≥1 and most (97%) were at low risk for bleeding (HAS-BLED score <3). Rhythm control was given to 55.1% of the patients. Anticoagulation for stroke prevention was provided to 69.5% of the eligible patients, while aspirin was used in 35%. CONCLUSION: The IRAF Registry has provided a systematic collection of contemporary data regarding the management and treatment of AF in Iran. Oral anticoagulant was used in 69.5%, but aspirin use was still common.
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Fibrilação Atrial , Acidente Vascular Cerebral , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Fatores de RiscoRESUMO
BACKGROUND: There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications. METHODS: This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death. RESULTS: Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc ≥ 500 ms and ∆QTc ≥ 60 ms was observed in 11.2% and 17.6% of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38% and 9.8% of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment. CONCLUSION: This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP.
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COVID-19 , Preparações Farmacêuticas , Torsades de Pointes , Eletrocardiografia , Feminino , Humanos , Irã (Geográfico) , Estudos Prospectivos , SARS-CoV-2 , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/epidemiologiaRESUMO
BACKGROUND: The aim of the present study was to determine whether postprocedural antibiotic reduces the risk of infection related to the cardiac implantable electronic device (CIED) implantations. METHODS: The present investigation is a randomized, prospective, single-blinded controlled trial. All consecutive patients who presented for new CIED implantation, generator replacement, or upgrade were randomized into the following three groups: (A) no antibiotic, (B) intravenous (IV) antibiotic for 1 day, (C) 1 day IV plus 7 days oral antibiotic. Follow-up was performed on 10-12 days; 1, 3, 6 months; and then every 6 months for 2 years. The primary endpoint was any evidence of infection at the generator pocket or systemic infection related to the procedure at short-term (6-month) and long-term (2-year) follow-ups. RESULTS: Of the 450 patients (72 patients with cardiac resynchronization device) included in the study, the primary endpoint of short-term infection was reached in one patient (0.2%) in group A and no patients in groups B and C. The endpoint of long-term infection was reached in nine patients (2%) with equal frequency between three randomized groups (three patients in each group). On multivariable analysis, the only independent predictor of infection was defibrillator implantation (odds ratio, 8.5; 95% confidence interval, 1.6-45). CONCLUSIONS: The results of this prospective study showed no benefit for the postoperative antibiotic for the prevention of CIED infection.
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Antibioticoprofilaxia , Desfibriladores Implantáveis/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Cuidados Pós-Operatórios/métodos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Adulto JovemRESUMO
Residual fibrous structures, referred as "ghosts", are occasionally encountered following lead extraction. Though typically detected in patients with cardiac device infections, their prognostic and therapeutic implications remain speculative. We describe a 62-year-old gentleman with history of sick sinus syndrome who presented atrial fibrillation with rapid ventricular response. The patient had history of transvenous lead extraction following pacemaker pocket infection 6 months earlier. In echocardiography, an echo-dense tubular lead-like structure was seen that followed the route of a pacer lead from superior vena cava to right atrium and then passing through the tricuspid valve into right ventricle.
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Artefatos , Remoção de Dispositivo , Ecocardiografia/métodos , Marca-Passo Artificial , Humanos , Masculino , Pessoa de Meia-Idade , TempoRESUMO
In this study, we combine heat diffusion equation and modified Hodgkin-Huxley axonal model to investigate how an action potential is generated during infrared neural stimulation. The effects of temporal and spatial distribution of heat induced by infrared pulsed lasers on variation of electrical membrane capacitance are investigated. These variations can lead to depolarize the membrane and generate an action potential. We estimate the threshold values of laser light parameters such as energy density, pulse duration, and repetition rate are needed to trigger an action potential. In order to do it, we present an analytic solution to heat diffusion equation. Then, the analytic results are verified by experimental results. Furthermore, the modified Hodgkin-Huxley axonal model is applied to simulate the generation of action potential during infrared neural stimulation by taking into account the temperature dependence of electrical membrane capacitance. Results show that the threshold temperature increase induced by a train infrared pulse laser can be smaller if repetition rate is higher. These results also indicate that temperature rise time and axon diameter influence on threshold temperature increase. To verify threshold values estimated by the presented method, we use a train infrared pulsed laser (λ = 1450 nm with repetition rate of 3.8 Hz, pulse duration of 18 ms and energy density of 5 J/cm2) to optically pace an adult rat heart, and we are able to successfully pace the rat heart during an open-heart surgery. The presented method can be used to estimate threshold values of laser parameters required for generating an action potential, and it can provide an insight to how the temperature changes lead to neural stimulation during INS.
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Raios Infravermelhos , Lasers , Sistema Nervoso/efeitos da radiação , Potenciais de Ação/efeitos da radiação , Animais , Axônios/efeitos da radiação , Membrana Celular/efeitos da radiação , Masculino , Imagens de Fantasmas , Ratos , Temperatura , Fatores de TempoRESUMO
BACKGROUND: With increasing use of cardiac resynchronization therapy (CRT), treating physicians should be familiar with different electrocardiographic (ECG) patterns of left ventricular (LV) lead and biventricular (BiV) pacing. However, there are a few publications on ECG patterns during BiV pacing. PURPOSE: This study was sought to determine different ECG patterns in patients with BiV pacing. METHODS: Twelve-lead ECGs during BiV pacing (right ventricular leads at apex and LV leads in one of the lateral coronary veins) were analyzed in 181 consecutive patients (121 male; mean age, 62.0 ± 13.5 years) with advanced heart failure and baseline left bundle branch block pattern after at least 6-month of uncomplicated CRT. RESULTS: During BiV pacing, 65% of the patients showed a dominant R wave in V1. There was a right axis deviation in 57% in frontal plane. However, a left superior axis emerged in 34% and normal frontal plane axis in 9%. Sequential BiV pacing (73% vs. 58%, P = 0.04) and pacing from posterolateral coronary vein (80% vs. 60%, p = 0.045) were more likely to present with a dominant R wave in V1. In sequential pacing, AV interval was significantly longer in patients with negative complex in V1 than in those with positive complex (124 ± 21 vs. 116 ± 8.0, p = 0.005). A Q/q wave was detected in 85% of patients in lead I and 78% in lead aVL. CONCLUSIONS: BiV pacing from lateral coronary venous branches and right ventricular apex characteristically presented with dominant R wave in V1, Q/q wave in leads I and aVL, and right or left superior axis. However, a negative complex in V1, QRS axis in other quadrants, and lack of Q/q wave in leads I and aVL did not necessarily indicate a problem.
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BACKGROUND: Recently, the phase analysis of gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has become feasible via several software packages for the evaluation of left ventricular mechanical dyssynchrony. We compared two quantitative software packages, quantitative gated SPECT (QGS) and Emory cardiac toolbox (ECTb), with tissue Doppler imaging (TDI) as the conventional method for the evaluation of left ventricular mechanical dyssynchrony. METHODS AND RESULTS: Thirty-one patients with severe heart failure (ejection fraction ≤35%) and regular heart rhythm, who referred for gated-SPECT MPI, were enrolled. TDI was performed within 3 days after MPI. Dyssynchrony parameters derived from gated-SPECT MPI were analyzed by QGS and ECTb and were compared with the Yu index and septal-lateral wall delay measured by TDI. QGS and ECTb showed a good correlation for assessment of phase histogram bandwidth (PHB) and phase standard deviation (PSD) (r = 0.664 and r = 0.731, P < .001, respectively). However, the mean value of PHB and PSD by ECTb was significantly higher than that of QGS. No significant correlation was found between ECTb and QGS and the Yu index. Nevertheless, PHB, PSD, and entropy derived from QGS revealed a significant (r = 0.424, r = 0.478, r = 0.543, respectively; P < .02) correlation with septal-lateral wall delay. CONCLUSION: Despite a good correlation between QGS and ECTb software packages, different normal cut-off values of PSD and PHB should be defined for each software package. There was only a modest correlation between phase analysis of gated-SPECT MPI and TDI data, especially in the population of heart failure patients with both narrow and wide QRS complex.
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Técnicas de Imagem por Elasticidade/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imagem de Perfusão do Miocárdio/métodos , Software , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Disfunção Ventricular Esquerda/diagnóstico , Algoritmos , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Proibitinas , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: There are only limited prospective data on the clinical relevance of current of injury (COI) as a predictor of the midterm performance of active-fixation leads. This study sought to investigate whether it is possible to predict the midterm performance of active-fixation leads using COI recorded at the time of implantation. METHODS AND RESULTS: One hundred fifty patients (78 men; mean age, 63 ± 19 years) who received active-fixation pacing (n = 201) and defibrillator (n = 51) leads were studied. COI was measured from the intracardiac bipolar electrogram recorded at the time of lead implantation. The study outcome was good lead performance at 6 months, defined as P wave ≥ 1.5 mV, threshold <1.5 V for atrial lead, R-wave ≥ 5 mV, and threshold <1 V for ventricular lead. A total of 102 active-fixation atrial and 150 ventricular leads were implanted. During a 6-month follow-up, invasive intervention was required for seven atrial and seven ventricular leads. In multivariate analysis, COI was the only independent predictor of good outcome for the active-fixation atrial (odds ratio [OR]: 5.67, 95% confidence interval [CI]: 2.18-14.76, P = 0.001) and ventricular leads (OR: 3.99, 95% CI: 1.08-21.26, P = 0.002). Receiver-operating characteristic analysis identified ST-segment elevation ≥2.0 mV for the atrial leads (sensitivity, 75%; specificity, 89%) and ≥10.0 mV for the ventricular leads (sensitivity, 70%; specificity, 87%) as optimal cutoffs for good midterm performance. CONCLUSIONS: Midterm performance of active-fixation leads is predictable using COI recorded at the time of lead implantation. A ST-segment elevation ≥2.0 mV in the atrial leads and ≥10.0 mV in the ventricular leads are recommended to improve the lead performance at 6 months.
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Fibrilação Atrial/terapia , Eletrodos Implantados , Marca-Passo Artificial , Disfunção Ventricular Esquerda/terapia , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologiaRESUMO
BACKGROUND: Atrial fibrillation (AF) augments the risk of stroke by 4-5 times. Vitamin D is pivotal in numerous metabolic pathways. A handful of studies have explored the correlation between vitamin D deficiency (VDD) and AF outcomes. Hence, the authors sought to assess the relationship between VDD and AF outcomes. METHODS: From December 2021 to February 2023, 190 patients with AF were incorporated into the authors' study. Given the seasonal fluctuation of vitamin D levels, these levels were examined from the start of December until the end of March. RESULTS: The final analysis comprised 190 patients (55.8% male) with an average age of 46.22±15.03. Vitamin D deficiency, insufficiency, and sufficiency were noted in 77 (40.5%), 46 (24.2%), and 67 (35.3%) patients, respectively. Fatigue and syncope were significantly more prevalent in the VDD group than in other groups. Three-vessel disease was more frequent in the VDD group (p-value=0.04). Mortality was more prevalent in patients with VDD (6.31%) compared to the VDI (2.10%) and VDS (0.05%) groups (p = 0.03). Successful cardioversion was significantly more prevalent in the VDS group (p = 0.03). CONCLUSION: A sufficient level of vitamin D was linked with a better response to cardioversion. However, low vitamin D levels are correlated with higher mortality in AF patients.
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Background: Recent studies investigating the effects of fish oil on shocks administered by ICDs in patients with ventricular tachycardias produced inconclusive results. This systematic review aims to evaluate the effectiveness of omega-3 polyunsaturated fatty acids in lowering the risk of life-threatening VTs among individuals with implantable cardioverter-defibrillators. Methods: We searched five databases, including Central, PubMed, EMBASE, Web of Science, and Scopus, for studies evaluating the efficacy of omega-3 polyunsaturated fatty acids (PUFAs) for the prevention of ICD events for VT or VF, published up to December 1, 2023. Results: Four trials were finally included in the study. The pooled risk ratios for mortality and ICD events were 0.87 (95% CI:0.58-1.32) and 0.75 (95% CI:0.48-1.18), respectively. Conclusion: No significant effect was discovered to support the antiarrhythmic properties or survival advantages of n-3 polyunsaturated fatty acids (PUFA) in individuals with implanted implantable cardioverter-defibrillators (ICD).
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Introduction: The Atrial Fibrillation Better Care (ABC) pathway is such an integrated care approach, recommended in guidelines. The aim of this service evaluation study was to evaluate the impact of implementing the ABC pathway in Iranian population. Methods: In this prospective longitudinal cohort study, consecutive patients with a diagnosis of AF were initially evaluated. Patients at baseline were evaluated in hence of adherence to ABC pathway strategy. After study enrolment, first and second follow-up service evaluations were conducted at 6 and 12 months, respectively. Results: The use of vitamin K antagonists (VKA) decreased from 25.1 % at enrolment to 13.8 % at follow-up; instead, non-VKA oral anticoagulants (NOAC) utilization increased from 40.0 % to 86.1 %, while antiplatelet treatment decreased from 34.9 % to 0 %. Use of antihypertensive drugs, ARBs, diuretics, and statins increased after implementation of the ABC pathway. Implementation of the ABC pathway approach led to a decrease in the occurrence of stroke/TIA (from 6.3 % to 2.2 %, p = 0.002), systemic thromboembolism (from 1.4 % to 0.0 %, p = 0.04), nose bleeds (from 0.8 % to 0.6 %, p = 0.04), skin bruising (from 1.2 % to 0.0 %, p = 0.002), and heart failure (from 7.7 % to 4.7 %, p = 0.04). The proportion of patients in EHRA Class I-II increased from 93.3 % at enrolment to 98.1 % at follow-up. Conclusion: In this first study from a Middle East population, compliance with ABC pathway strategy in the management of AF was associated with optimization of management and general improvements in patient outcomes during follow-up.