Increased baseline ECG R-R dispersion predicts improvement in systolic function after atrial fibrillation ablation.

BackgroundAtrial fibrillation (AF) is associated with left ventricular (LV) systolic dysfunction which may improve after AF ablation. We hypothesised that increased ventricular irregularity, as measured by R-R dispersion on the baseline ECG, would predict improvement in the left ventricular ejection fraction (LVEF) after AF ablation.MethodsPatients with LVEF <50% at two US centres (2007-2016), having both a preablation and postablation echocardiogram or cardiac MRI, were included. LVEF improvement was defined as absolute increase in LVEF by >7.5%. Multivariable logistic regression (restricted to echocardiographic/ECG variables) was performed to evaluate predictors of LVEF improvement.ResultsFifty-two patients were included in this study. LVEF improved in 30 patients (58%) and was unchanged/worsened in 22 patients (42%). Those with versus without LVEF improvement had an increased baseline R-R dispersion (645±155 ms vs 537±154 ms, p=0.02, respectively). The average baseline heart rate in all patients was 93 beats per minute. After multivariable logistic regression, increased R-R dispersion (OR 1.59, 95% CI 1.00 to 2.55, p=0.03) predicted LVEF improvement.ConclusionsIncreased R-R dispersion on ECG was independently associated with improved systolic function after AF ablation. This broadens the existing knowledge of arrhythmia-induced cardiomyopathy, demonstrating that irregular electrical activation (as measured by increased R-R dispersion on ECG) is associated with a cardiomyopathy capable of improving after AF ablation

Yaşlı bir kadın hastada karbamazepine bağlı atriyoventriküler blok

WOS:000371267200012PubMed ID: 26875133Seksen sekiz yaşında bir kadın hasta acil servise oturur iken bayılma şikayeti ile başvurdu. Elektrokardiyogra- mında ileri derecede kalp bloğu görüldü. Trigeminus nevral- jisi için son bir yıldır günde 200 mg dozunda karbamazepin almakta imiş. Karbamazepin kesildikten sonra hastada kalp bloğu ortadan kalktı ve hasta başka bir girişim yapılmadan taburcu edildi.An 88-year-old woman was admitted to the emergency department after experiencing syncope while in a sitting position. Electrocardiogram showed advanced degree heart block. She has been on low-dose carbamazepine (200 mg/day) for the last year for trigeminal neuralgia (TN). After discontinuation of carbamazepine, the patient returned to normal sinus rhythm

Pyridostigmine in the treatment of postural orthostatic tachycardia syndrome

Otuz dört yaşında kadın hasta yaklaşık bir yıldır ayakta duramama, ayakta iken çarpıntı, baş dönmesi, halsizlik ve yorgunluk şikayetleri ile kliniğimize başvurdu. Hastanın rutin incelemeleri normaldi. Hastanın ayakta şikayeti olmadan 1 dakikadan daha az süre durabildiği tespit edildi. Yapılan eğik-masa testinde kan basıncında düşüş olmadan 5. dakikada kalp hızında başlangıç değerine göre 55 atım/dakika artış olurken hastada çarpıntı, halsizlik ve terleme şikayetleri ortaya çıktı. Hastada postüral ortostatik taşikardi sendromu tanısı düşünülerek piridostigmin tedavisi başlandı. Tedavinin dördüncü ayında hastanın semptomları hemşirelik mesleğini yürütebilecek kadar azalmıştı.A 34-year-old female patient was admitted with the complaints of inability to stand upright, palpitations, diz- ziness, and fatigue in the upright posture for the last one year. She was found to stand upright for less than one min- ute without symptoms. Tilt table testing showed that, com- pared to baseline her heart rate increased 55 beats/min in the fifth minute of the test with the symptoms of palpitations, fatigue and sweating without any significant change in her blood pressure. Postural orthostatic tachycardia syndrome was diagnosed, and pyridostigmine treatment was started. Four months after treatment her symptoms were relieved so that she was able to function as a nurse

“Atrial torsades de pointes” Induced by Low-Energy Shock From Implantable-Cardioverter Defibrillator

A 58 year-old-patient developed an episode of polymorphic atrial tachycardia which looked like "atrial torsades de pointes" after a 5J shock from implantable cardioverter defibrillator

Cardiac imaging in evaluating patients prone to sudden death

Identifying subjects who are at risk for SCD and stratifying them correctly into low or high-risk groups is the holy grail of Cardiology. While imaging shows a lot of promise, it is plagued by the fact that most SCD occurs in relatively healthy subjects, a massive group who would not ordinarily be subjected to imaging. Left ventricular ejection fraction (LVEF) currently is our primary parameter for risk stratification for sudden cardiac death but is a poor marker with low sensitivity and specificity. Current data shows that sophisticated imaging with techniques, mainly Cardiac magnetic resonance Imaging (CMR), have the potential to identify novel high-risk markers underlying SCD, beyond ejection fraction. Imaging seems to further refine risk in patients with low LVEF as well as in those with normal EF; this is a major strength of advanced imaging. Clinical application has been slow and not fully prime time. It is important to remember that while promising, imaging techniques including CMR, have not been tested in rigorous prospective studies and thus have not as yet replaced EF as the gatekeeper to ICD implantation