Latent atriofascicular pathway participating in a wide complex tachycardia: Differentiation from ventricular tachycardia

Accessory pathways with anterograde decremental conduction properties usually are characterized by presence of antegrade preexcitation during atrial pacing. We report a 38-year-old man with frequent episodes of palpitation. No evidence of ventricular preexcitation was seen during sinus rhythm or atrial pacing. All electrophysiologic maneuvers were compatible with an antidromic tachycardia using atriofascicular pathway as the antegrade limb and the atrioventricular nodal pathway as retrograde limb. Radiofrequency ablation at recording site of accessory pathway potential resulted in cure of tachycardia with no recurrence during 3-month follow-up. This report indicated that atriofascicular pathway-mediated tachycardia should be considered in differential diagnosis of all cases of wide complex tachycardia with left bundle branch morphology and left axis. © 2006, The Authors

The effects of coenzyme Q10 supplementation on lipid profiles among patients with coronary artery disease: A systematic review and meta-analysis of randomized controlled trials

Background Chronic inflammation and increased oxidative stress significantly contribute in developing coronary artery disease (CAD). Hence, antioxidant supplementation might be an appropriate approach to decrease the incidence of CAD. This systematic review and meta-analysis was aimed to determine the effects of coenzyme Q10 (CoQ10) supplementation on lipid profile, as one of the major triggers for CAD, among patients diagnosed with coronary artery disease. Methods EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science were searched for studies prior to May 20th, 2018. Cochrane Collaboration risk of bias tool was applied to assess the methodological quality of included trials. I-square and Q-tests were used to measure the existing heterogeneity across included studies. Considering heterogeneity among studies, fixed- or random-effect models were applied to pool standardized mean differences (SMD) as overall effect size. Results A total of eight trials (267 participants in the intervention group and 259 in placebo group) were included in the current meta-analysis. The findings showed that taking CoQ10 by patients with CAD significantly decreased total-cholesterol (SMD -1.07; 95% CI, − 1.94, − 0.21, P = 0.01) and increased HDL-cholesterol levels (SMD 1.30; 95% CI, 0.20, 2.41, P = 0.02). We found no significant effects of CoQ10 supplementation on LDL-cholesterol (SMD -0.37; 95% CI, − 0.87, 0.13, P = 0.14), lipoprotein (a) [Lp(a)] levels (SMD -1.12; 95% CI, − 2.84, 0.61, P = 0.20) and triglycerides levels (SMD 0.01; 95% CI, − 0.22, 0.24, P = 0.94). Conclusions This meta-analysis demonstrated the promising effects of CoQ10 supplementation on lowering lipid levels among patients with CAD, though it did not affect triglycerides, LDL-cholesterol and Lp(a) levels. Keywords: Coenzyme Q10 Lipid profiles Coronary artery disease Meta-analysi

The effects of coenzyme Q10 supplementation on biomarkers of inflammation and oxidative stress in among coronary artery disease: a systematic review and meta-analysis of randomized controlled trials

Objective: Systemic inflammation and oxidative stress significantly contribute in developing coronary artery disease (CAD). This systematic review and meta-analysis was aimed to determine the effects of coenzyme Q10 (CoQ10) supplementation on biomarkers of inflammation and oxidative stress among patients with CAD. Methods: The electronic databases including MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library databases were systematically searched until Oct 2018. The quality assessment and heterogeneity of the selected randomized clinical Trials (RCTs) were examined using the Cochrane Collaboration risk of bias tool, and Q and I 2 tests, respectively. Given the presence of heterogeneity, random-effects model or fixed-effect model were used to pool standardized mean differences (SMDs) as summary effect sizes. Results: A total of 13 clinical RCTs of 912 potential citations were found to be eligible for the current meta-analysis. The pooled findings for biomarkers of inflammation and oxidative stress demonstrated that CoQ10 supplementation significantly increased superoxide dismutase (SOD) (SMD 2.63; 95 CI, 1.17, 4.09, P < 0.001; I 2 = 94.5) and catalase (CAT) levels (SMD 1.00; 95 CI, 0.57, 1.43, P < 0.001; I 2 = 24.5), and significantly reduced malondialdehyde (MDA) (SMD � 4.29; 95 CI � 6.72, � 1.86, P = 0.001; I 2 = 97.6) and diene levels (SMD � 2.40; 95 CI � 3.11, � 1.68, P < 0.001; I 2 = 72.6). We did not observe any significant effect of CoQ10 supplementation on C-reactive protein (CRP) (SMD � 0.62; 95 CI � 1.31, 0.08, P = 0.08; I 2 = 87.9), tumor necrosis factor alpha (TNF-α) (SMD 0.22; 95 CI � 1.07, 1.51, P = 0.73; I 2 = 89.7), interleukin-6 (IL-6) (SMD � 1.63; 95 CI � 3.43, 0.17, P = 0.07; I 2 = 95.2), and glutathione peroxidase (GPx) levels (SMD 0.14; 95 CI � 0.77, 1.04, P = 0.76; I 2 = 78.7). Conclusions: Overall, this meta-analysis demonstrated CoQ10 supplementation increased SOD and CAT, and decreased MDA and diene levels, but did not affect CRP, TNF-α, IL-6, and GPx levels among patients with CAD. © 2019, Springer Nature Switzerland AG

Predictors and frequency of conduction disturbances after open-heart surgery

Introduction: The risk of developing conduction disturbances after coronary bypass grafting (CABG) or valvular surgery has been well established in previous studies, leading to permanent pacemaker implantation in about 2 to 3 of patients, and in 10 of patients undergoing repeat cardiac surgery. We sought to determine the incidence, features and predictors of conduction disorders in the immediate post-operative period of patients subjected to open-heart surgery, and the need for permanent pacemaker implantation. Material and Method: We prospectively studied 374 consecutive patients who underwent open-heart surgery in our institution: coronary artery bypass (CABG) (n=128), Mitral valve replacement(MVR) (n=18), aortic valve replacement(AVR) (n=21), MVR and AVR(n=56), repair of ventricular septal defect (VSD) (n=51), repair of tetralogy of Fallot (TOF) (n=57),CABG and valvular surgery (n=6), others (n=37). Results: Among 374 patients included in our study (mean age 34.46±25.68; 146 males), 192 developed new conduction disorders: symptomatic sinus bradycardia in 8, atrial fibrillation with slow ventricular response (AF) in 4.5, first-degree atrioventricular block (AVB)in 6.4, second-degree AVB in 0.3 third-degree AVB in 7, new right bundle branch block (RBBB) in 33, and new left bundle branch block (LBBB) in 2.1. In 5.6 patients, a permanent pacemaker was implanted, 47.6 of them underwent valvular surgery. In 44.1 of patients the conduction defects occurred in the first 48 hr. after surgery. In CABG group, 29.7 of patients developed new conduction disturbances; the most common of them was symptomatic sinus bradycardia. After valvular surgery 44.2 of patients developed conduction disturbances, of those the most common was atrial fibrillation with slow ventricular response. After VSD and TOF repair, the most common conduction disturbance was new RBBB. Perioperative myocardial infarction (MI) occurred in 1.9 of patients. The occurrence conduction disturbance was compared with patient age, sex, occurrence of perioperative MI, ejection fraction (EF), postoperative use of �-adernergic receptor blocking agents and digitalis and type of cardiac surgery. By regression analysis there was a correlation between type of surgery and new conduction defects, being significant for CABG and TOF repair. Only the occurrence of perioperative MI was related to PPM implantation. Conclusion: Irreversible AVB requiring a PPM is an uncommon complication after open-heart surgery. Peri-operative MI is a risk factor

Investigation of Erythema, Radiation Dose, and Radiation-Induced Apoptosis in the Peripheral Blood Lymphocytes of Patients Treated with Radiofrequency Catheter Ablation

Introduction: The long-term use of fluoroscopy in cardiac interventional procedures increases the patient dose and causes severe skin reactions, which lead to growing concern. The aim of the present study was to evaluate the risk and the effect of X-ray irradiation on apoptosis in the peripheral blood lymphocytes of patients treated with ablation in electrophysiological studies. Material and Methods: A total of 30 patients who underwent ablation therapy participated in this study. The absorbed dose in the given area was measured by a thermos luminescent dosimeter (TLD). The duration of dose delivery, absorbed dose by the apparatus, and dose area product (DAP) factor were measured for each patient. The skin changes were observed within the 1st day to 5th week after the operation. Blood sampling was conducted (before and 24 h after the treatment), and then, flow cytometry was performed to investigate the apoptotic changes in the blood lymphocytes. Results: The statistical analysis showed that there was a significant difference in the apoptosis of patient blood lymphocytes before irradiation and following that (P<0.05). There was a correlation between the amount of DAP and TLD dose (P<0.001). Furthermore, a correlation was observed between the total apoptosis and fluoroscopic time. The patient radiation dose in the ablation test was not in the threshold level required to create skin erythema. Conclusion: The results of the present study revealed that the use of long-time fluoroscopy in electrophysiological studies may cause a significant increase of apoptosis in the peripheral blood lymphocyte of patients treated using this procedure. © 202

Can successful radiofrequency ablation of atrioventricular nodal reentrant tachycardia be predicted by pattern of junctional ectopy?

Background: Emergence of junctional rhythm (JR) during radiofrequency (RF) current delivery directed at the periatrioventricular nodal region has been shown to be a marker of success in atrioventricular nodal reentrant tachycardia (AVNRT). Whereas the characteristics of JR during RF ablation of slow pathway have already been studied, the electrophysiologic features of different patterns of JR are yet to be evaluated. The aim of this study was to investigate in detail the characteristics of the JR that develops during the RF ablation of the slow pathway. Materials and Results: The study population consisted of 95 patients: 56 women and 33 men (mean age, 47.2 ± 16.3 years) who underwent slow pathway ablation because of AVNRT. A combined anatomical and electrogram mapping approach was used, and AVNRT was successfully eliminated in all patients. This study identified 7 patterns for JR during the RF ablation of slow pathway: junction-junction-junction, sinus-junction-sinus, intermittent burst, sparse, no junction, sinus-junction-junction, and sinus-junction-block . The characteristics of JR, such as mean cycle length and total number, were gathered. The incidence of JR was significantly higher during effective applications of RF energy than during ineffective applications (P = .001). The mean number of junctional ectopy was 19.6 ± 19. The total number of junctional ectopy was significantly higher during effective applications of RF energy than during ineffective applications (24.6 ± 18.8 vs 8.4 ± 13.2; P < .001). We found a significant difference between the effective and ineffective applications of RF energy in the mean cycle length of the junctional ectopy (464.6 ± 167.5 vs 263.4 ± 250.2; P < .01). The patterns of JR were compared between effective and ineffective applications. We managed to show a significant correlation between patterns of JR and successful ablation (P = .01). Logistic regression analysis revealed that the presence of sinus-junction-sinus, sinus-junction-junction, and sinus-junction-block patterns of JR was a predictor of a successful RF ablation (confidence interval CI, 1.67-15.92 P < .004; CI, 1.02-85.62 P = .048; and CI, 1.06-32.02 P = .042, respectively). Conclusion: This study confirms that JR is often present during successful slow pathway ablation. The pattern of JR is useful as indicator of success. © 2008 Elsevier Inc. All rights reserved