Convergent double coronary sinus potentials during atrial tachycardia

The analysis of the patterns and timing of coronary sinus activation provides a rapid stratification of the most likely macro-re-entrant atrial tachycardias and points toward the likely origin of centrifugal ones by comparing the left atrial and coronary sinus activation sequence and morphology during sinus rhythm and atrial tachycardia. The analysis of both the near- and far-field electrogram morphology of atrial signals also gives important clues in determining the mechanism of the arrhythmia

Modified model for end-stage liver disease score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units

Objectives The Model for End-stage Liver Disease excluding the international normalised ratio that is derived from prothrombin time which is calculated as a ratio of the patient's prothrombin time to a control prothrombin time standardized (MELD-XI) and modified MELD, which uses albumin in place of the international normalised ratio (MELD-Albumin) scores reflect liver and renal function and are predictors of mortality. However, their prognostic value in acute pulmonary embolism (APE) has not been studied. Design We assessed the predictive value of the MELD scores in patients diagnosed with high-risk APE admitted to the intensive care unit. The primary outcome was 30-day mortality. Results Of the 273 patients included in the study, 231 were survivors and 42 were non-survivors. The mortality rate was 15.3%. The mean MELD-XI and MELD-Albumin scores were significantly higher in the non-survivors than in the survivors (MELD XI, 11.8 +/- 1.8 and 10.6 +/- 1.43, respectively; p = .002; MELD-Albumin, 10.5 +/- 1.6 and 8.7 +/- 1.1, respectively; p = .001). The multiple logistic regression analysis identified the MELD-XI (hazard ratio: 3.029, confidence interval: 1.06-1.21, p = .007) and MELD-Albumin (hazard ratio: 1.13, confidence interval: 1.06-1.21, p = .002) scores as independent predictors of mortality. Receiver operating characteristic analysis revealed that the predictive power of the MELD-Albumin score (0.871 +/- 0.014; p < .001) was higher than those of the MELD-XI (0.726 +/- 0.022, p < .001), APACHE III (0.682 +/- 0.024, p < .001), and PESI (0.624 +/- 0.023, p < .001) scores. Conclusions The MELD-Albumin score is an easily calculable, reliable, and practical risk assessment tool and independent predictor of 30-day mortality in patients with high-risk APE

Evaluation of the relationship between coronary slow flow phenomenon and serum magnesium levels

Aim: Coronary slow flow phenomenon (CSFP) is a microvascular circulation disorder. It is known that serum magnesium has positive effects on anti-inflammation, vasodilatation and endothelial functions. This observational study investigated the association of serum magnesium levels with CSFP.Materials and Methods: Patients who had undergone coronary angiography (CAG) after noninvasive testing were included in the study. CAG records were reassessed for CSFP and 100 patients were diagnosed as having CSFP. Control subjects (n = 80) had normal coronary flow. Serum Mg levels and other biochemical parameters such as glucose, creatinine, cholesterol levels and hemoglobin samples were collected before CAG. Serum Mg values were categorized into two groups: Mg levels equal/under and above 1.9 mg/dL.Results: The mean patient age was 56.1±9.7 years; 68.9% of patients were men. Patient’s hypertension, diabetes mellitus history and smoking habits rate were similar between groups. Biochemical tests revealed lower serum magnesium levels (1.87 vs 1.95mg/dL, p=0.02) for CSFP patients and controls, respectively. In multivariate regression analysis, a serum magnesium level under 1.9 mg/dL (OR:3.33, 95% CI:1.75-6.37, p<0.001) and male gender (OR:2.08, 95% CI: 1.016-4.34, p=0.04) were found to be independent predictors of CSFP.Conclusion: Low serum magnesium levels were associated with CSFP. However, these results are not sufficient to fully determine the role of Mg levels in the mechanism of CSFP-related chest pain

An Analysis on Coronary Artery Disease Severity with Serum Adropin Level in Patients with Acute ST-Segment Elevation Myocardial Infarction

Objective Adropin is associated with energy balance in tissues and organs. The SYNTAX score (SS) is used to determine the severity of ST-segment elevation myocardial infarction(STEMI). The aim of this study was to determine the relationship between serum adropin levels and disease severity in STEMI patients.Materialsand MethodsEighty-nine patients who underwent coronary angiography (CAG) for STEMI were included in the study. The STEMI patients were divided into two subgroups: Group 1(SS< 22) and Group 2 (SS ≥ 23). 43 patients who underwent CAG and had normal coronary arteries were included in the study as a control group.Results Groups 1 and 2 included more male participants than the control group (89.7% and 74.2% vs. 34.9%, respectively, p < 0.001). The smoking rate was higher in Groups 1 and2 than in the control group (55.1% and 34.4% vs. 11.6%, respectively, p≤0.001). Serum adropin levels were lower in Group 1 than in the control group (147.3 ± 149.2 mg/Land 228.1 ± 253.3 ng/L, p = 0.03). Serum adropin levels were the lowest in Group 2 (87.8 ± 23.2 ng/L, 147.3 ± 149.2 ng/L, and 228.1 ± 253.3 ng/L, p = 0.004). Serum adropinlevels were also negatively correlated with SS (r = -0.33, p = 0.002).Conclusion Serum adropin levels decreased more in STEMI patients than in those without coronary artery disease (CAD). In addition, serum adropin levels decreased with increasingSS;this indicates the severity of CAD

Unusual response to His-synchronous ventricular stimulation during a supraventricular tachycardia: Atrial advancement with or without resetting?

A59‐year‐old man underwent a diagnostic electrophysiology studybecause of rapid palpitations and documented supraventriculartachycardia (SVT) unresponsive to metoprolol therapy. His 12‐leadelectrocardiogram was normal. Baseline atrio‐His and His‐ventricularintervals measured 48 and 48 ms, respectively. Programmed atrialextrastimulation using single atrial extrastimuli repeatedly induced hisSVT. The response to His refractory ventricular extra stimulations(Hr‐VESs) is shown in Figure1. Based on the information, what arethe mechanisms of his tachycardia and apparently discordantresponses

Dynamic changes in atrial activation sequence during supraventricular tachycardia

A29‐year‐old woman presented with repeated paroxysms ofpalpitations resulting from a rapid narrow QRS complex tachycar-dia (NCT). Her family and personal history were free of anycardiovascular pathology. After the initiation of an NCT following a1:2 ventricular response to programmed atrial stimulation(Figure1), a premature ventricular complex (PVC) from the rightparahisian region was delivered at a time when the His bundleactivation was completed (Figure2); subsequently, a dynamicchange in the retrograde atrial activation sequence (AAS) andventriculoatrial (VA) intervals were developed (Figure3). Based onthe findings within the figures, what is the mechanism of tachycardia