Strategy to manage T-Wave Oversensing in a Biventricular ICD

T-wave oversensing is a relatively prevalent cause of intracardiac signals oversensing in patients with Implantable Cardioverter Defibrillator (ICD). Some of these oversensings are typically corrected with device reprogramming. If reprogramming fails to resolve the issue, invasive options such as repositioning the implanted lead may be necessary. We present a patient with dilated cardiomyopathy and intermittent T wave oversensing by a cardiac resynchronization therapy (CRT) that was managed by altering V-V timing

The Correlation between Serum Level of N-Terminal Pro-B-type Natriuretic Peptide and Gensini Score in Patients with Acute Coronary Syndrome

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has emerged as an important biomarker for developing the diagnosis and prognosis of cardiovascular diseases, as several studies have shown that serum levels of NT-proBNP elevate in acute coronary syndrome (ACS) and coronary artery disease (CAD). We performed this study to find any possible correlation between serum levels of NT-proBNP and Gensini score in patients diagnosed with ACS.Methods: In a cross-sectional study, 100 consecutive patients with ACS who were candidates of angiography were recruited and their serum levels of NT-proBNP, Gensini scores, lipid profiles and troponin I levels were measured.Results: Sixty six male and 34 female patients with a mean age of 57.5 years, including 44 with unstable angina, 33 with ST-elevation myocardial infarction, and 23 with non-ST-elevation myocardial infarction were enrolled. The mean serum NT-proBNP level and the Gensini score were 1987.16 pg/mL (17.9-8841) and 31.09 (6-92.5), respectively. The serum NT-proBNP levels and Gensini scores were significantly correlated with a Spearman correlation coefficient of 0.953 (P < 0.001). Serum levels of NT-proBNP were not different in patients with single-vessel disease, 2-vessel disease and 3-vessel disease (P = 0.257). NT-Pro-BNP levels were also correlated positively with troponin I levels (correlation coefficient = 0.779) and negatively with left ventricular ejection fraction (correlation coefficient = -0.55). Smoker patients had higher NT-proBNP levels (P = 0.047). Neither Gensini scores nor NT-Pro-BNP levels had significant correlation with lipid profile or blood sugar.Conclusions: NT-proBNP is directly correlated with Gensini score in patients with ACS and might be used as an important marker for risk stratification in those patients

Changes of Left Ventricular Mass Index Among End-Stage Renal Disease Patients After Renal Transplantation

Purpose: The aim of this study was to determine left ventricular (LV) mass index via echocardiography in end-stage renal disease patients (ESRD) before and after renal transplantation, and its association with one-year survival. Materials and Methods: Forty-seven patients with ESRD who were candidate for renal transplantation were evaluated with echocardiography before and 4 months after the operation. Left ventricular ejection fraction (EF), LV mass, and LV mass index were determined. All of the patients were followed up for 1 year.Results: Mean LVEF was 51.6% which increased to 53.7% after renal transplantation (P = .001). Mean LV mass was 209 gr before the operation which decreased to 189 gr after the operation (P = .001). Mean LV mass index before the operation was 120 gr/m2 which decreased to 110 gr/m2 following the operation (P = .002). All of the patients survived during 1-year follow-up, and no death was reported.Conclusion: Renal transplantation had beneficial effects in terms of LV function in young patients with ESRD

Institutional Ownership and Investment Efficiency: Evidence from Iran

Investment efficiency shows how well a company invests its assets. Although institutional shareholders play undeniable roles in companies, it is not clear whether they are able to monitor managers and make investment decisions or not. This study gives answers to stakeholders, addresses concerns about the effect of the owners on investment efficiency, and aims to add to the literature on emerging markets by investigating the relationship in Iran, a different environment from developed ones. Based on monitoring power, the shareholders are divided into two types: active and passive ones. Investment problems are classified into two types: over- and under-investment problems. The sample consists of 101 firms listed on the Tehran Stock Exchange between 2010 and 2016. Some regression models are used. The results illustrated that institutional owners have a positive effect on investment efficiency and decrease both over- and under-investment problems and so, the efficient monitoring school is approved. Additionally, active ones are positively correlated with investment efficiency and decrease both investment inefficiency problems. Institutional ownership is the cause of investment efficiency, not the reverse. Based on findings, in emerging markets like Iran’s market, investors are recommended to give notice to the level of active ownership in firms; ownership structure is a good sign of efficiency

Successful Implantation of Coronary Sinus Lead after Balloon Angioplasty of a Coronary Vein Stenosis

A 55-year-old man referred for cardiac resynchronization therapy (CRT) due to severe heart failure. A severe stenosis in the coronary sinus vein after the posterior branch disallowed the insertion of the lead. Nevertheless, the stenosis was dilated and the left ventricle (LV) lead was implanted in the lateral marginal branch

Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

Background: Primary percutaneous coronary intervention (primary PCI) is the method of choice in establishing reperfusion in acute myocardial infarction (AMI) patients. The aim of this study was to determine the success rate of primary PCI in a university medical center in Iran with a view to promoting it as a first-line therapy in patients with AMI, especially in centers with established catheterization labs across the country. Methods: All cases of AMI admitted between September 2001 and September 2005 underwent primary PCI. The achieved thrombolysis in myocardial infarction (TIMI) flow was recorded, and the patients were followed during the hospital admission for major adverse cardiac events (MACE). Results: A total of 180 patients, consisting of 36 females and 144 males, with a mean age of 56±2.1 years were included in the study. The target vessel was the left anterior descending artery in 66.1%, right coronary artery in 27.2%, and left circumflex artery in 6.7% of the cases. The respective rate of anatomical and procedural success was 94.4% and 90%. The rates of mortality, coronary artery bypass grafting (CABG), and reinfarction were 6.7%, 1.1%, and 2.2%, respectively. Most patients were discharged with no complications in less than a week. Anatomical success in patients <65 years old was 95% versus 92.5% for those ³ 65 years of age. Procedural success in patients <65 years of age was 93.6% versus 77.5% for those ³65 years old (P<0.05). No significant relation was detected between the success rate and sex, target vessel, or major coronary artery disease risk factors. More patients in the mortality group had a longer door-to-balloon (DTB) time compared to the surviving group (P<0.05). Conclusion: In light of the results of this study, primary PCI may also be practiced as the therapy of choice for AMI patients in centers with established equipment in our region with acceptable rates of MACE and complications. Better procedural success rates are achieved in younger patients and in those with a shorter DTB time

Carotid Artery Stenting: A Single-Center Experience

Background: Carotid artery stenting is now used as an alternative to surgical endarterectomy. This study was done to assess the feasibility, safety, and immediate and late clinical outcomes in patients undergoing carotid stenting.Methods: Between July 2008 and December 2009, a total of 40 patients (20 male, mean age: 65 ± 11 years, 19 symptomatic, and 90% high risk for endarterectomy) underwent carotid artery stenting with different embolic protection devices and carotid stents. Thirty-seven patients had coronary artery disease. Technical success rate, stroke/death/ myocardial infarction rate at 30 days, access-site complications, and contrast-induced nephropathy were assessed. For the evaluation of the influence of experience in carotid artery stenting on complications, the patients were divided into two groups: Group 1 included the first 20 treated patients and Group 2 comprised the remainder of the patients.Results: The overall technical success rate was 100%. The cumulative in-hospital stroke death rate was 7.5% (n = 3: 2 deaths and 1 major stroke). Complications were more frequent in Group 1 (2/20, 10%; 2 deaths) than in Group 2 (1/20, 5%; 1 major stroke), but this was not statistically significant (p value = 0.09). No access-site complications occurred, and mild contrast-induced nephropathy occurred in 3 patients (7.5%). No major stroke or neurological deaths occurred during a mean follow-up of 12 months.Conclusion: Carotid stenting seemed feasible and relatively safe in our experience. Advanced experience in carotid artery stenting appears to confer an acceptable peri-procedural stroke-death rate

Prevention of Atrioventricular Block During Radiofrequency Ablation by Pace Mapping of Koch’s Triangle

Background: Complete atrioventricular block (AV block) is a serious complication of slow pathway ablation therapy in the treatment of atrioventricular nodal re-entrant tachycardia (AVNRT). The present study was aimed at determining whether the electroanatomical pace mapping of Koch’s triangle could significantly improve the safety, efficiency, and efficacy of selective slow pathway ablation in the treatment of AVNRT. Methods: A total number of 124 patients were selected to be studied consecutively for radiofrequency (RF) ablation therapy in the treatment of AVNRT. The subjects were divided into two groups: one, designated Group 1, to serve as the control group, and the other, designated Group 2, to serve as the study group. Conventional fluoroscopic slow pathway ablation was performed on the Group 1 subjects (n=66), with the Group 2 subjects receiving slow pathway ablation therapy guided by pace mapping of Koch’s triangle. The slow pathway ablation in Group 2 (n=58) was performed with regard to the pace mapping data obtained on the basis of the St-H interval in the anteroseptal (AS), midseptal (MS), and posteroseptal (PS) regions of Koch’s triangle. The anterograde fast pathway (AFP) location was determined based on the shortest St-H interval obtained by stimulating the anteroseptal (AS), midseptal (MS), and posteroseptal (PS) aspects of Koch’s triangle. Results: In the Group 2 subjects, AFP location was AS in 50 (86.2%) of the cases, MS in 7 (12%) of the cases, and PS in 1 case (1.7%). One patient with posteroseptal AFP was administered retrograde fast pathway ablation therapy. One patient in the control group (Group 1), representing 1.5% of the group, developed persistent AV block in the course of the treatment, but none of the subjects in the study group (Group 2) developed any complications. Conclusion: It was concluded that an atypical fast pathway location is conducive to the development of atrioventricular block in the ablation therapy in AVNRT, with pace mapping of Koch’s triangle having the capacity to eliminate the risk of any such complication developing. It follows that it helps to identify the AFP location before ablation therapy is administered in AVNRT, thereby improving the safety of the treatment