Predictors of permanent pacemaker insertion after mitral valve replacement: A systematic review.

As the established surgical mitral valve replacement (MVR) expands toward various contemporary techniques and access routes, the predictors and burden of procedure-related complications including the need for permanent pacemaker (PPM) implantation need to be identified. Digital databases were searched systematically to identify studies reporting the incidence of PPM implantation after MVR. Detailed study and patient-level baseline characteristics including the type of study, sample size, follow-up, number of post-MVR PPM implantations, age, gender, and baseline ECG abnormalities were abstracted. A total of 12 studies, recruiting 37,124 patients were included in the final analysis. Overall, 2820 (7.6%) patients required a PPM with the net rate ranging from 1.7% to 10.96%. Post-MVR atrioventricular (AV) block was the most commonly observed indication for PPM, followed by sinoatrial (SA) node dysfunction, and bradycardia. Age, male gender, pre-existing comorbid conditions, prior CABG, history of arrhythmias or using antiarrhythmic drugs, atrial fibrillation ablation, and double valve replacement were predictors of PPM implantation post-MVR. Age, male gender, comorbid conditions like diabetes and renal impairment, prior CABG, double valve replacement, and antiarrhythmic drugs served as positive predictors of PPM implantation in patients undergoing MVR.

Co-occurrence of familial Mediterranean fever with systemic lupus erythematosus in South Asian population.

BACKGROUND AND OBJECTIVE: Familial Mediterranean fever (FMF) and systemic lupus erythematosus (SLE) are autosomal recessive auto-inflammatory diseases, triggered by FMF-associated gene mutations and auto-antigens. The literature on the co-occurrence of these two disorders is limited to case reports and their correlation is considered rare. We investigated the proportion of FMF among SLE patients when compared with a healthy adult cohort in South Asia. METHODS: For this observational study, data from our institutional database were collected for the patients diagnosed with SLE. The control group was randomly selected from the database and were age- matched for SLE. The overall proportion of FMF among patients with and without SLE was considered. Student's t-test, Chi-square, and ANOVA were used for univariate analysis. RESULTS: The study population included 3623 SLE patients and 14,492 controls. In the SLE group, there was a significantly higher proportion of FMF patients compared with the non-SLE group (1.29% vs. 0.79% respectively; p=0.015). SLE was prevalent in Pashtun's (50%) in the middle socioeconomic group while FMF was dominant in Punjabi's and Sindhi's (53%) in the low socioeconomic class. CONCLUSION: This investigation demonstrates that FMF is more prevalent in a South-Asian population cohort of SLE patients.

Post-acute COVID-19 syndrome and its prolonged effects: An updated systematic review.

Objective: This systematic review aimed at estimating the prevalence of post-acute COVID-19 symptoms in view of published literature that studied prolonged clinical manifestations after recovery from acute COVID-19 infection. Methods: Relevant databases were searched for extraction of articles. For data synthesis, based on the distribution of quantitative variables, they were expressed as mean ± standard deviation (SD) or median and interquartile range (IQR). Qualitative variables were presented as frequency (n) and percentages (%). Results: Twenty-one articles qualified for the final analysis. The most common persistent clinical manifestations were fatigue (54.11%), dyspnea (24.38%), alopecia (23.21%), hyperhidrosis (23.6%), insomnia (25.98%), anxiety (17.29%), and arthralgia (16.35%). In addition to these symptoms, new-onset hypertension, diabetes, neuropsychiatric disorders, and bladder incontinence were also reported. Conclusion: Clinical features of post-acute COVID-19 infection can manifest even after 60 days of initial infection. Multidisciplinary care along with regular follow-up must be provided to such patients.

Tricuspid insufficiency after cardiac-implantable electronic device placement.

OBJECTIVE: Device-related estimates of incidence and significance of tricuspid regurgitation (TR) is mainly based on case reports and small observational studies. We sought to determine whether right-heart device implantation increased the risk of TR in this interventional study. METHODS: All patients who underwent permanent pacemaker (PPM) or other device implantation were assessed for degree of TR at one year. The data collected was analyzed on IBM SPSS version 26. Descriptive statistics were applied for qualitative variables. Mean and standard deviation were applied for quantitative variables. Regression analysis and paired t-tests were applied for the degree of change and predictors of TR. RESULTS: Out of 165 participants, 73.94% were male. The mean age of the participants was 59.86 ± 12.03 years. Dual-chamber pacemaker (DDDR) was the most common device implanted (78.18%) causing significant TR and drop in left ventricular ejection fraction as compared to other devices (p-value < 0.05). The paired t-test for changes in ejection fraction (LVEF) and TR were also significant (p-value < 0.05). A regression model predicted significant TR to depend on baseline LVEF (p-value < 0.05). CONCLUSION: Device-related worsening of TR is related to mechanical mechanisms. It is significantly associated with DDDR pacemakers after a 1-year follow-up.