جستجوی مقالات مرتبط با کلیدواژه « atrial fibrillation » در نشریات گروه « پزشکی »

Poisoning with Organophosphates (OP) and/or Pyrethroids (PYR) pesticides is common. We present a rare case of OP+PYR poisoned patient who suffered from Atrial Fibrillation (AF) at the beginning of treatment by a low dose of atropine and reviewed the literature. 

A 50-year-old man had ingested about 5-10 ml of a mixture of chlorpyrifos/cypermethrin.  Half an hour later, he went to the rural hospital and 2 hr later, after gastrointestinal decontamination, he was referred to the clinical toxicology department with normal vital signs except normal sinus tachycardia [Heart rate (HR)]=105. On admission, he had nausea, vomiting, diarrhea, mild sialorrhea, symmetric mid-size pupils, wet skin, and bilateral moist rales in his lungs. His cardiac rhythm changed to rapid AF (HR >140 beats/min) after treatment with 3 mg midazolam followed by 0.3 mg of atropine (0.1 mg every 1-3 min). Atropine administration was discontinued and he was treated with 0.5 mg of digoxin. 6 hr later, his arrhythmia disappeared and all cardiac and laboratory evaluations changed to normal except reduced serum cholinesterase activity.  

AF may be induced by Organophosphates (OP) and Pyrethroids (PYR) intoxication or during the treatment by atropine. We could not find any known risk factor (cardiac or medical issues) for AF in the current case. It may be suggested that poisoning with OP, PYR (alone or mixed) or atropine (in general or in low dose), or combination is the trigger of AF. However, AF is not life threating and can easily cure by antiarrhythmic therapy.

Corilagin (Cor) is reported as beiing hepatoprotective, anti-inflammatory, antibacterial, and anti-oxidant, while the effect on atrial fibrosis remains unknown. Therefore, we investigated the protective effect of Cor in angiotensin II (Ang II)-induced atrial fibrosis and atrial fibrillation (AF).

C57BL/6 mice (male, 8–10 weeks, n = 40) were subcutaneously infused either with saline or Ang II (2.0 mg/kg/day) and Cor (30 mg/kg) intraperitoneally injected 2 hr before Ang II infusion for 4 weeks. Mice were grouped into the control group (n=8), Cor group (n=8), Ang II group (n=8), and Ang II + Cor group (n=8). Morphological, histological, and biochemical examinations were performed. In vivo, transesophageal burst pacing was used to generate AF.

Cor treatment markedly reduced Ang II-induced AF development in mice. Ang II + Cor therapy potentially decreased the atrial fibrotic area. It significantly decreased the increase in smooth muscle alpha-actin (α-SMA), CTGF, Collagen I, and Collagen III expressions brought on by Ang II treatment. Moreover, Ang II + Cor treatment remarkably decreased the malondialdehyde (MDA) content, whereas superoxide dismutase (SOD) and catalase (CAT) activities were potentially increased (all, P<0.001). In addition, Ang II + Cor significantly reduced Ang II-induced interleukin 1 beta (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNF-α) concentrations in atrial tissues. Furthermore, Cor significantly inhibited Ang II-induced p-PI3K, p-Akt, and NF-κB p-p65 protein expression in atrial tissues. 

Our data speculated that Cor could have a protective effect against Ang II-induced atrial fibrosis and AF via down-regulation of the PI3K-Akt pathway.

Allelic variants of genes encoding enzymes of the esterase system (CES1) and P-glycoprotein (ABCB1) can change the metabolism and pharmacokinetics of dabigatran. Therefore, they act as determining factors in the development of side effects, especially bleeding. We analyzed the genotype–phenotype relationship of ABCB1 (rs1045642, rs4148738, rs2032582, and rs1128503) and CES1 (rs8192935, rs71647871, and rs2244613) polymorphisms in patients with atrial fibrillation who had been treated with dabigatran.

A total of 150 patients were recruited for this study. TaqMan technology was used for SNP genotyping.

Patients with the rs2244613 GG genotype had a lower concentration (55.27 ± 34.22 ng/ml) compared to those with the TT genotype (63.33 ± 52.25 ng/ml) (additive model, P = 0.000). Individuals with the rs8192935 AA genotype had a lower concentration (52.72 ± 30.45 ng/ml) compared to those with the GG genotype (79.78 ± 57 ng/ml) (additive model, P = 0.001). The APTT values among the different genotypes of the ABCB1 SNPs, rs4148738 and rs1045642, were significantly different (P = 0.035 and P = 0.024, respectively).

Our research demonstrates that the CES1 polymorphisms, rs8192935 and rs2244613, are associated with the pharmacodynamics and pharmacokinetics of dabigatran in the Kazakh subpopulation.

Rheumatic heart disease (RHD) is the leading cause of heart disease worldwide, accounting for 90% of all heart disorders in women of childbearing age, and also accounts for 10% to 15% of maternal mortality.

Amiodarone is a purposive medicine useful in restoring sinus rhythm (SR) after cardiac surgery. The aim of the study was to evaluate the effect of prophylactic intraoperative single-dose intravenous amiodarone and to convert atrial fibrillation (AF) into normal sinus rhythm (NSR) in the patients undergoing valve replacement surgery.

In this prospective and interventional study, 180 patients of ASA III (American Society of Anesthesiologist) classification between the ages of 18-60 years, posted for Rheumatic Mitral Valve Replacement were allocated randomly to two equal groups (Group-1 and Group-2). Their hemodynamics parameters, Pre and post pulse rate, ECG findings and incidence of AF and VT/VF and ICU, Hospital stay were noted. Data was analysed with SPSS v26 using chi-square test. A two-tailed P value of 0.05 or less was regarded as statistically significant.

In our study, we found that there was suggestive significance between both groups as regard to mean pulse rate changes after 5 and 10 minutes of induction (P value >0.05). At the end of surgery, there was developing atrial fibrillation in few patients and sinus rhythm in more (P value >0.05). Postoperative arrhythmias in the first 24 hrs, AF was seen in 9(10%) patients in the Group 1 compare to Group 2 49 (54.4%) (P <0.001). In both groups as regard to Mechanical ventilation & ICU stay was of suggestive significance in amiodarone group (P value <0.0001).

The incidence of post-operative AF among high-risk patients was significantly reduced by a prophylactic amiodarone treatment resulting in a shorter time of intensive care unit and hospital stay.

Atrial Fibrillation (AF) is one of the most common type of heart arrhythmias observed in the clinical practice. AF can be detected using Electrocardiogram (ECG). ECG signal are time varying and nonlinear in nature. Hence, it is very difficult for a physician to perform accurate and rapid classification of different heart rhythms, manually. In this paper we propose a method using Discrete Wavelet Transform (DWT) with db6 as basis function for denoising ECG signal along with Savitzky- Golay filter to smoothen the signal. Deep learning methods, such as combination of Convolutional Neural Network (CNN) and Long Short Term Memory (LSTM) (CNN-LSTM) and ResNet18 are used for accurate classification of ECG signal using Physionet Challenge 2017 database. With 10-fold cross validation method the model provided overall accuracy of 98.25% with CNN-LSTM classifier.

Introduction: 

Cardioversion for atrial fibrillation (AF) is routinely implemented in daily practice; however, it can be associated with the development of recurrent AF. In this study we aimed to evaluate the predictors of AF recurrence after electrical cardioversion, and to compare the outcomes of patients with or without AF recurrence during follow-up.

Methods:

 Patients with persistent AF were enrolled from March 2015 to September 2018. Patients with recurrent AF within 6 months after the index cardioversion were considered as AF recurrence (AFR) group, and those with normal sinus rhythm were defined as normal sinus rhythm (NSR) group. Thereafter, all patients were followed up for the incidence of adverse events, including death, requiring dialysis, coronary artery intervention/surgeries, cerebrovascular events, heart failure, and recurrent AF beyond 6 months.

Results: 

Of 129 patients, 11 patients had failed cardioversion and 7 patients lost to follow-up. So, 34 and 77 patients were categorized as the NSR and the AFR groups. During a median follow-up time of 54 (46-75) months, there was a trend for a higher incidence of major adverse events in the AFR group compared to the NSR group (P=0.063). Lower body mass index (odds ratio [OR] 0.885, 95% confidence interval [CI] 0.794-0.986, P=0.027) and coarse AF before the index cardioversion (OR 3.846, 95% CI 1.189-12.443, P=0.025) were the independent predictors of recurrent AF.

Conclusion: 

In patients with persistent AF undergoing cardioversion, the presence of coarse AF and the lower values of body mass index were found to be associated with the AF recurrence.

Atrial fibrillation (AF) augments the risk of stroke by 4-5 times. Vitamin D is pivotal in numerous metabolic pathways. A handful of studies have explored the correlation between vitamin D deficiency (VDD) and AF outcomes. Hence, the authors sought to assess the relationship between VDD and AF outcomes. From December 2021 to February 2023, 190 patients with AF were incorporated into the authors’ study. Given the seasonal fluctuation of vitamin D levels, these levels were examined from the start of December until the end of March. The final analysis comprised 190 patients (55.8% male) with an average age of 46.22±15.03. Vitamin D deficiency, insufficiency, and sufficiency were noted in 77 (40.5%), 46 (24.2%), and 67 (35.3%) patients, respectively. Fatigue and syncope were significantly more prevalent in the VDD group than in other groups. Three-vessel disease was more frequent in the VDD group (p-value=0.04). Mortality was more prevalent in patients with VDD (6.31%) compared to the VDI (2.10%) and VDS (0.05%) groups (p = 0.03). Successful cardioversion was significantly more prevalent in the VDS group (p = 0.03). A sufficient level of vitamin D was linked with a better response to cardioversion. However, low vitamin D levels are correlated with higher mortality in AF patients.

It is extremely rare to encounter primary malignant tumors of the heart. Rhabdomyoma constitutes approximately 20% of all primary malignant tumors of the heart. Rhabdomyoma commonly arises from the ventricular wall, and rarely, they arise from the atrial wall and mimic symptomatic atrioventricular valve stenosis. We describe an extremely rare case of left atrial (LA) rhabdomyosarcoma detected during the transesophageal echocardiography arising from the posterior wall of the left atrium protruding into the left ventricle causing obstruction of the mitral valve. Our case is a rare case of LA rhabdomyosarcoma presenting with mitral inflow obstruction and symptomatically mimicking severe rheumatic mitral stenosis with atrial fibrillation and fast ventricular rate with orthopnea secondary to LA failure and passive pulmonary venous congestion.

Recent randomized controlled trials have demonstrated the benefit of patent foramen ovale (PFO) device closure over medical therapy alone for secondary prevention of cryptogenic stroke in carefully selected patients. In the current study, we sought to investigate the outcomes and complications of PFO device closure in our referral tertiary cardiovascular center.

In this retrospective study, 155 adult patients who underwent PFO device closure between 2006 and 2021 were included. Patient characteristics, recurrent neurologic events, and procedure-related complications were evaluated.

The follow-up period was 2.3 ± 1.2 years. The average age of the participants was 41.3 ± 10 years, and 59.4% were male. Six patients(3.9%) suffered recurrent cerebrovascular events in the follow‑up. No procedure‑related complications were reported in our study population. Two patients (1.3%) with recurrent stroke had developed newly diagnosed atrial fibrillation (AF).

PFO device closure is a safe and effective method for the prevention of recurrent ischemic stroke in patients with no other detectable etiology. Patients, particularly those with cardiovascular risk factors, should be meticulously investigated for the asymptomatic episodes of AF as the contributing factor with prolonged Holter monitoring or use of loop recorders.

Atrial fibrillation (AF) is a life threatening disease and can cause stroke, heart failure, and sometimes death. To reduce the rate of mortality and morbidity due to increased prevalence of AF, early detection of the same becomes a prior concern. Traditional machine learning (TML) algorithms and ensemble machine learning (EML) algorithms are proposed to detect AF in this article. The performances of both these methods are compared in this study. Methodology involves computation of RR interval features extracted from electrocardiogram and its classification into: normal, AF, and other rhythms. TML techniques such as Classification and Regression Tree, K Nearest Neighbor, C4.5, Iterative Dichotomiser 3, Support Vector Machine and EML classifier such as Random Forest (RF), and Rotation Forest are used for classification. The proposed method is evaluated using PhysioNet challenge 2017. During the tenfold cross validation, it is observed that RF classifier provided good classification accuracy of 99.10% with area under the curve of 0.998. Apart from contributing a new methodology, the proposed study also experimentally proves higher performance with ensemble learning method, RF. The methodology has many applications in health care management systems including defibrillators, cardiac pacemakers, etc.

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF.

The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared.

Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513). The frequency of AF was 31% in the atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 and P=0.161) and in-hospital and 3-month mortality (P=0.315 and P=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Our logistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01).

Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.

The systemic immune-inflammation index (SII) has recently been investigated for cardiovascular diseases. We aimed to evaluate the relationship between SII and left atrial thrombosis (LAT).

This retrospective, case-control study recruited patients with nonvalvular atrial fibrillation (NVAF) who underwent transesophageal echocardiography (TEE) for LAT detection before cardioversion or catheter ablation at a tertiary hospital between 2012 and 2021. Demographic characteristics were obtained from the hospital data system. According to TEE findings, the patients were categorized into LAT (+) and (-) groups. Age, gender, history of chronic diseases, urea, creatinine, albumin, hemogram parameters, the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), SII, the CHADS₂ score, the CHA₂DS₂-VASc score, echocardiographic parameters, antiaggregant-anticoagulant use, and nonparoxysmal atrial fibrillation were included and analyzed.

The study population consisted of 403 patients, including 228 men (56.6%), at a mean age of 60.84±12.26 years. A high white blood cell count (WBC) (OR, 1.26; 95% CI, 1.05 to 1.51; P=0.013), a high SII (OR, 1.00, 95% CI, 1.00 to 1.00; P=0.003), and a low ejection fraction (OR, 0.95; 95% CI, 0.90 to 0.99; P=0.018) were independent predictors of LAT (+). A spontaneous echo contrast (OR, 2.43; 95% CI, 1.35 to 4.39; P=0.003) was associated with LAT (+). SII values above 693.6 predicted LAT (+) with 71.6% sensitivity and 71.7% specificity (AUC, 0.77; P<0.001). The predictiveness of SII was similar to that of NLR (0.77 vs 0.74, P=0.093) but higher than PLR (0.77 vs 0.67; P<0.001) and WBC (0.77 vs 0.69; P=0.031).

SII is an independent predictor of LAT in patients with NVAF.

Introduction:

A comprehensive conclusion has yet to be made about the predictive value of serum N-terminalpro-brain natriuretic peptide (NT-proBNP) for stroke/systemic embolic events (SEE) in patients with atrial fib-rillation (AF). This study aims to review the evidence for evaluating the value of NT-proBNP in predicting the riskof stroke/SEE in patients with AF through a systematic review and meta-analysis.

Two independentreviewers screened all relevant studies that were retrieved from the database of Medline, Embase, Scopus, andWeb of Science until December 7th, 2021. The predictive value of NT-proBNP in the prediction of stroke/SEEwas recorded as hazard ratio (HR) and 95% confidence interval (95% CI).

Nine articles (38,093 patients,3.10% stroke/SEE) were included in our analysis. There was no publication bias in these studies (P=0.320). Ouranalysis showed that NT-proBNP can be a good predictor of stroke/SEE risk in AF patients, even at differentcut-off values (HR=1.76; 95% CI: 1.51, 2.02; P < 0.001). Subgroup analysis showed that diabetes could have apossible effect on the predictive value of NT-proBNP (meta-regression coefficient = 0.042; P = 0.037).Conclu-sion:Measurement of NT-proBNP during the first admission could be used to assess the short- or long-termrisk of stroke/SEE in patients with AF. Further studies are needed to evaluate the possible applicability of serumNT-proBNP measurement in the settings in which stroke is the sole outcome of the investigation.

Burned-out hypertrophic cardiomyopathy (BO-HCM) is complicated by substantial adverse events. However, few studies have focused on clinical or echocardiographic features and their prognostic values among patients with BO-HCM.

This study evaluated the clinical manifestations and prognostic value of echocardiography in patients with BO-HCM.

The present retrospective study evaluated 401 consecutive patients referred to the echocardiography ward of Rajaie Cardiovascular Center for evaluation of HCM during the period from January 2010 to February 2018. Three hundred six patients who completed the follow-up were included: 78 (25.4%) had BO-HCM and an EF of < 50% (group 1), and 228 (74.5%) had a normal EF in their baseline TTE (group 2). Among the group 2 population, 183 patients had a preserved EF of > 50% (group 2B), and 45 became BO-HCM at the end of their follow-up (group 2A). Clinical data were analyzed, including medical history, electrocardiography, and echocardiography. Generalized estimating equation (GEE) regression was performed to assess the association between patient characteristics and burned-out HCM.

An atrial fibrillation (AF) rhythm was more common in the groups with BO-HCM (groups 1 and 2A) (32.8 vs. 14%; P = 0.002), as were Frequent premature ventricular contractions (PVCs) (13.98 vs. 5%; P = 0.040). Moderate or severe systolic anterior motion (SAM) was significantly more common in group 2B (LVEF > 50%) compared with group 1 and 2A, who had an EF of ≤ 50% (32.3% vs. 7.6%; P = 0.006). The S-wave of the right ventricle was significantly lower in groups 1 and 2A (9.73 vs. 11.8 cm/s; P < 0.001). Systolic pulmonary artery pressure (SPAP) was significantly higher in groups 1 and 2A (38.28 vs. 29.74 mmHg, P < 0.001). The differences in the prevalence of asymmetrical septal hypertrophy (ASH), left ventricular outlet (LVOT) obstruction, pericardial effusion (PE), diastolic dysfunction, and mitral regurgitation (MR) were insignificant between all groups.

Among the patients suffering from HCM, the presence of AF rhythm, frequent PVCs, significant RV dysfunction, and absence of systolic anterior motion (SAM) of mitral valve leaflets have prognostic value and might be considered predictors for progression to BO-HCM.

Renal infarction is rare and may be considered acute renal colic in presentation. In this report, we describe a case of renal infarction caused by thrombosis that extended from the aortoiliac to the infrapopliteal segment, along with thrombosis that occurred in the right popliteal artery and left atrium. A 48-year-old man was referred to the emergency department (ED) suffering left flank pain. The pain was significant with radiation to the left lower quadrant, and the pain did not significantly decrease despite intravenous ketorolac and morphine sulfate administration. We decided to perform a color Doppler ultrasound test of intraabdominal vessels that revealed low flow in the left iliac artery. By computed tomography angiography (CTA), it was confirmed that the left renal, iliac, and popliteal arteries were thrombosed. The patient underwent anticoagulation, thrombectomy, and Mitral valve replacement surgery during the hospitalization. After 14 days, his heart rhythm returned to normal sinus and he was discharged from the hospital with proper outpatient follow-up. Patients with severe flank pain and who do not respond to routine treatments, especially patients with significant risk factors, should be evaluated more carefully for red flag diagnosis.

Electrical cardioversion or intravenous ibutilide are currently recommended as the acute treatment for preexcited atrial fibrillation. Recent guidelines for this circumstance forbid intravenous amiodarone despite its effectiveness in blocking the accessory pathway and atrioventricular node due to the possibility of ventricular fibrillation. But as our presented case, some physicians continued to favor intravenous amiodarone successfully in a suitable setting.