Notching early repolarization pattern in inferior leads increases risk of ventricular tachyarrhythmias in patients with acute myocardial infarction: a meta-analysis.

The aim of this of this meta-analysis was to examine the potential association between certain early repolarization (ER) characteristics and ventricular tachyarrhythmias (VTAs) in patients with acute myocardial infarction (AMI). We searched PubMed, Embase and Web of Science databases for records published until December 2014. Of the 658 initially identified records, 7 studies with a total of 1,565 patients (299 with ER and 1,266 without ER) were finally analyzed. Overall, patients with ER displayed a higher risk of VTAs following AMI compared to patients without ER [odds ratio (OR): 3.75, 95% CI: 2.62-5.37, p \u3c 0.00001]. Subgroup analyses showed that the diagnosis of ER prior to AMI onset is a better predictor of VTAs (OR: 5.70, p \u3c 0.00001) compared to those diagnosed after AMI onset (OR: 2.60, p = 0.00001). Remarkably, a notching morphology was a significant predictor of VTAs compared to slurring morphology (OR: 3.85, p = 0.002). Finally, an inferior ER location (OR: 8.85, p \u3c 0.00001) was significantly associated with increased risk of VTAs in AMI patients. In conclusion, our meta-analysis suggests that ER pattern is associated with greater risk of VTAs in patients with AMI. A notched ER pattern located in inferior leads confers the highest risk for VTAs in AMI

Corak Pemikiran Dan Gerakan Aktivis Perempuan (Melacak Pandangan Keagamaan Aisyiyah Periode 1917–1945)

This paper discusses the patterns of religious thought of the women activistsin the early period of Aisyiyah. The women activists are Siti Walidah, Siti Bariyah, SitiAisyah, Siti Badilah, Siti Munjiyah, Siti Badilah, Siti Hayyinah, dan Siti Umniyah.Through ahistorical approach, the author founds a link between colonialism that occurin Muslim countries and the revival of the spirit of women activists in mobilizing theMuslims society. The author also asserts that the thought of Aisyiyah leaders includingin the Islamic modernism that mean are Islamists a progresive religion, Islam is areligion of liberation, enlighten and advance. This understanding is very influential inthe development of Aisyiyah recently. The formers of Aisyiyah aware of the importanceof women\u27s participation and role in Islamic Da\u27wah join with men to accelerate therealization of a prosperous society.Key words: Thought, women activists, AisyiyahMakalah ini membahas tentang corak pemikiran keagamaan perempuan aktivisgerakan Aisyiyah pada periode awal. Mereka adalah Siti Walidah, Siti Bariyah, SitiAisyah, Siti Badilah, Siti Munjiyah, Siti Badilah, Siti Hayyinah, dan Siti Umniyah.Melalui pendekatan historis, penulis menemukan kaitan antara gelombang kolonialismeyang terjadi di negara-negara muslim dengan semangat kebangkitan kaum perempuandalam menggerakkan kaum muslim khususnya kaum perempuan. Penulis jugamenegaskan bahwa pemikiran para tokoh Aisyiyah termasuk paham modernisme Islamyaitu Islam sebagai agama yang berkemajuan, agama dengan ajaran yang membebaskan,mencerahkan dan memajukan. Pemahaman ini sangat berpengaruh dalamperkembangan dakwah ‘Aisyiyah ke depan. Para tokoh Aisyiyah menyadari akanpentingnya perempuan berpartisipasi dan berperan dalam Dakwah Islam bersamasamadengan laki-laki untuk mempercepat terwujudnya masyarakat sejahtera

Sinus node disease in subjects with type 1 ECG pattern of Brugada syndrome

AbstractBackgroundThe spectrum of phenotypes related to mutations of the SCN5A gene include Brugada syndrome (BS), long QT syndrome, progressive cardiac conduction defect, and sinus node disease (SND). The present study investigated the incidence of SND in subjects with type 1 electrocardiogram (ECG) pattern of BS.Methods and resultsThe study population consisted of 68 individuals (55 males, mean age 44.8±12.8 years) with spontaneous (n=27) or drug-induced (n=41) type 1 ECG pattern of BS. Twenty-eight subjects were symptomatic with a history of syncope (41.2%). SND was observed in 6 symptomatic subjects (8.8%), and was mainly attributed to sino-atrial block with sinus pauses. Two patients were initially diagnosed with SND, and received a pacemaker. Patients with SND displayed an increased P-wave duration in leads II and V2, PR interval in leads II and V2, QRS duration in leads II and V2, and increased QTc interval in lead V2 (p<0.05). AH and HV intervals as well as corrected sinus node recovery time (cSNRT) were significantly prolonged in subjects with SND (p<0.05). During a mean follow-up period of 5.0±3.6 years, five subjects with a history of syncope suffered appropriate implantable cardioverter defibrillator (ICD) discharges due to ventricular arrhythmias (7.4%). None of those diagnosed with SND suffered syncope or ICD therapies.ConclusionSND is not an uncommon finding in subjects with type 1 ECG pattern of BS. The occurrence of SND in relatively young patients may deserve meticulous investigation including sodium channel blocking test

Circulating Vitamin D Concentrations and Risk of Atrial Fibrillation:A Mendelian Randomization Study Using Non-deficient Range Summary Statistics

Vitamin D deficiency is a common disorder and has been linked with atrial fibrillation (AF) in several observational studies, although the causal relationships remain unclear. We conducted a Mendelian randomization (MR) analysis to determine the causal association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and AF. The analyses were performed using summary statistics obtained for single-nucleotide polymorphisms (SNPs) identified from large genome-wide association meta-analyses conducted on serum 25(OH)D ( = 79,366) and AF ( = 1,030,836). Six SNPs related to serum 25(OH)D were used as instrumental variables. The association between 25(OH)D and AF was estimated using both the fixed-effect and random-effects inverse variance weighted (IVW) method. The MR analyses found no evidence to support a causal association between circulating 25(OH)D level and risk of AF using random-effects IVW (odds ratio per unit increase in log 25(OH)D = 1.003, 95% CI, 0.841-1.196; = 0.976) or fixed-effect IVW method (OR = 1.003, 95% CI, 0.876-1.148; = 0.968). Sensitivity analyses yielded similar results. No heterogeneity and directional pleiotropy were detected. Using summary statistics, this MR study suggests that genetically predicted circulating vitamin D concentrations, especially for a non-deficient range, were not causally associated with AF in the general population. Future studies using non-linear design and focusing on the vitamin D deficiency population are needed to further evaluate the causal effect of vitamin D concentrations on AF

Elevated Levels Within the Normal Limits of Liver Enzymes in Patients With Atrial Fibrillation

Background. Emerging evidence suggests that a strong link exists between certain liver enzymes such as γ-glutamyltransferase (γ-GT) and alanine transaminase (ALT) and cardiovascular diseases independently of alcohol intake. Elevated levels of γ-GT and ALT within normal values are considered as markers of inflammation and oxidative stress independent of the metabolic syndrome. Objective. This pilot observational study was conducted to evaluate serum levels of γ-GT and ALT within normal values in different atrial fibrillation (AF) populations. Methods. Consecutive patients with AF and healthy control subjects were screened. Clinical and echocardiographic characteristics were carefully recorded. In each participant, serum levels of γ-GT and ALT along with conventional inflammatory markers were determined. The final study population consisted of 81 patients with paroxysmal AF, 45 patients with persistent AF, and 39 control subjects. Results. Serum γ-GT levels within normal values were significantly elevated in patients with paroxysmal (30.40±12.34 U/L) and persistent AF (38.38±18.11 U/L) in relation to control population (24.03±11.73 U/L) (p&lt;0.001). Of note, γ-GT concentration was significantly higher in patients with persistent AF compared to those with paroxysmal AF (p: 0.010). Serum ALT levels were significantly higher in patients with paroxysmal (27.51±10.23 U/L) and persistent AF (28.73±9.34 U/L) compared to controls (20.26±9.34 U/L) (p&lt;0.001). In multinomial logistic regression analysis, the relative risk ratio of developing paroxysmal AF per 1 U/L increase in ALT was 1.08 (CI: 1.02-1.14, p: 0.011). The relative risk ratio of having persistent AF per 1 U/L increase in γ-GT was 1.06 (CI: 1.01-1.12, p: 0.013). Conclusions. This study shows an association between increased levels within normal reference intervals of liver enzymes such as γ-GT and ALT and AF. Serum γ-GT levels may be related to AF burden. Larger studies are needed to examine this potential association

Infectious consequences of hematoma from cardiac implantable electronic device procedures and the role of the antibiotic envelope: A WRAP-IT trial analysis.

Hematoma is a complication of cardiac implantable electronic device (CIED) procedures and may lead to device infection. The TYRX antibacterial envelope reduced major CIED infection by 40% in the randomized WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention Trial) study, but its effectiveness in the presence of hematoma is not well understood.The purpose of this study was to evaluate the incidence and infectious consequences of hematoma and the association between envelope use, hematomas, and major CIED infection among WRAP-IT patients.All 6800 study patients were included in this analysis (control 3429; envelope 3371). Hematomas occurring within 30 days postprocedure (acute) were characterized and grouped by study treatment and evaluated for subsequent infection risk. Data were analyzed using Cox proportional hazard regression modeling.Acute hematoma incidence was 2.2% at 30 days, with no significant difference between treatment groups (envelope vs control hazard ratio [HR] 1.15; 95% confidence interval [CI] 0.84-1.58; P = .39). Through all follow-up, the risk of major infection was significantly higher among control patients with hematoma vs those without (13.1% vs 1.6%; HR 11.3; 95% CI 5.5-23.2; P.001). The risk of major infection was significantly lower in the envelope vs control patients with hematoma (2.5% vs 13.1%; HR 0.18; 95% CI 0.04-0.85; P = .03).The risk of hematoma was 2.2% among WRAP-IT patients. Among control patients, hematoma carried a11-fold risk of developing a major CIED infection. This risk was significantly mitigated with antibacterial envelope use, with an 82% reduction in major CIED infection among envelope patients who developed hematoma compared to control

Programmed inappropriate ICD ventricular defibrillation for cardioversion of persistent atrial fibrillation

In this report we briefly describe a patient with a dual chamber implantable cardioverter defibrillator in the context of severe ischemic cardiomyopathy who developed persistent atrial fibrillation. After appropriate anticoagulation and under mild sedation the patient was successfully cardioverted to sinus rhythm after a programmed ventricular synchronized defibrillation using his defibrillator. Programmed internal cardioversion of persistent atrial fibrillation in patients who have an implantable cardioverter defibillator without atrial defibrillation capabilities could be an effective and safe therapeutic option. Unlike external electrical cardioversion, this strategy does not interfere with the implantable cardioverter defibrillator, is more effective, and obviates the need of general anesthesia. This strategy should be further evaluated in clinical trials

The role of cardiac magnetic resonance in identifying appropriate candidates for cardiac resynchronization therapy - a systematic review of the literature

Despite the strict indications for cardiac resynchronization therapy (CRT) implantation, a significant proportion of patients will fail to adequately respond to the treatment. This systematic review aims to present the existing evidence about the role of cardiac magnetic resonance (CMR) in identifying patients who are likely to respond better to the CRT. A systematic search in the MedLine database and Cochrane Library from their inception to August 2021 was performed, without any limitations, by two independent investigators. We considered eligible observational studies or randomized clinical trials (RCTs) that enrolled patients > 18 years old with heart failure (HF) of ischaemic or non-ischaemic aetiology and provided data about the association of baseline CMR variables with clinical or echocardiographic response to CRT for at least 3 months. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement). Following our search strategy, 47 studies were finally included in our review. CMR appears to have an additive role in identifying the subgroup of patients who will respond better to CRT. Specifically, the presence and the extent of myocardial scar were associated with increased non-response rates, while those with no scar respond better. Furthermore, existing data show that scar location can be associated with CRT response rates. CMR-derived markers of mechanical desynchrony can also be used as predictors of CRT response. CMR data can be used to optimize the position of the left ventricular lead during the CRT implantation procedure. Specifically, positioning the left ventricular lead in a branch of the coronary sinus that feeds an area with transmural scar was associated with poorer response to CRT. CMR can be used as a non-invasive optimization tool to identify patients who are more likely to achieve better clinical and echocardiographic response following CRT implantation. [Abstract copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.