Symptoms Of Palpitations Research Articles

Ranolazine reduces symptoms of palpitations and documented arrhythmias in patients with ischemic heart disease — The RYPPLE randomized cross-over trial

Background: Ranolazine decreases the frequency of arrhythmias during the acute phases of ischemic heart disease (IHD), but it remains unknown if it has similar effects in the chronic phase of the disease. We performed a prospective, randomized, cross-over pilot trial to test the hypothesis that chronic treatment with ranolazine can reduce the incidence of documented arrhythmias and the related symptoms of palpitation in stable patients with IHD. Methods: We randomized 105 patients with stable IHD and symptoms of angina and palpitations already on therapy with betablockers and/or calcium antagonists to ranolazine (750 mg bid, N = 53) or placebo (N = 52) for 30 days (until T-1). After a washout period to avoid any carryover effect, cross-over was performed,and patients were switched to the other drug which was continued for 30 days (until T-2). All patients underwent symptomlimited exercise stress testing and 48-hour ECG Holter monitoring at T1 and T2. During the study period, patients were told to use a OmronN® portable ECG monitor HCG-801 device in case of symptoms of palpitations. Results: Ranolazine reduced the number of anginal episodes more commonly than placebo (5 ± 8 episodes/30 days vs. 21 ± 24 episodes/30 day, p = 0.001) and increased exercise durations at 1 mm ST-segment depression (514 ± 211 s vs. 402 ± 287 s, p = 0.025) and at onset of angina (614 ± 199 s vs. 519 ± 151 s, p = 0.007) at stress testing. These effects were coupled by significant decreases with ranolazine as compared with placebo treatment periods in the occurrence of frequent (N1000 beats) supraventricular arrhythmias (33% vs 52%, p = 0.01) and complex ventricular arrhythmias (17% vs 30%, p = 0.045). Complete resolution of symptoms of palpitations was significantly more common with ranolazine than placebo (31/53 vs 16/52 patients, p = 0.008). Also, portable ECG recordings showed that arrhythmias were less common during ranolazine vs. placebo, with significant decreases in number (7 ± 10 episodes/30 days vs. 23 ± 29 episodes/30 day, p = 0.001) and duration (10 ± 18 min/ 30 days vs. 19 ± 21 min/30 day, p = 0.021) of symptomatic arrhythmic episodes. No severe side effects were recorded during the trial period. Conclusion: The antianginal and antiischemic properties of ranolazine are paralleled by significant decreases in the occurrence of both arrhythmias and the related symptoms of palpitations in stable patients with IHD. (ClinicalTrials.gov identifier: NCT01495520).

Pharmacodynamic effects of atorvastatin vs. rosuvastatin in coronary artery disease patients with normal platelet reactivity while on dual antiplatelet therapy — The PEARL randomized cross-over study

Background: Ranolazine decreases the frequency of arrhythmias during the acute phases of ischemic heart disease (IHD), but it remains unknown if it has similar effects in the chronic phase of the disease. We performed a prospective, randomized, cross-over pilot trial to test the hypothesis that chronic treatment with ranolazine can reduce the incidence of documented arrhythmias and the related symptoms of palpitation in stable patients with IHD. Methods: We randomized 105 patients with stable IHD and symptoms of angina and palpitations already on therapy with betablockers and/or calcium antagonists to ranolazine (750 mg bid, N = 53) or placebo (N = 52) for 30 days (until T-1). After a washout period to avoid any carryover effect, cross-over was performed,and patients were switched to the other drug which was continued for 30 days (until T-2). All patients underwent symptomlimited exercise stress testing and 48-hour ECG Holter monitoring at T1 and T2. During the study period, patients were told to use a OmronN® portable ECG monitor HCG-801 device in case of symptoms of palpitations. Results: Ranolazine reduced the number of anginal episodes more commonly than placebo (5 ± 8 episodes/30 days vs. 21 ± 24 episodes/30 day, p = 0.001) and increased exercise durations at 1 mm ST-segment depression (514 ± 211 s vs. 402 ± 287 s, p = 0.025) and at onset of angina (614 ± 199 s vs. 519 ± 151 s, p = 0.007) at stress testing. These effects were coupled by significant decreases with ranolazine as compared with placebo treatment periods in the occurrence of frequent (N1000 beats) supraventricular arrhythmias (33% vs 52%, p = 0.01) and complex ventricular arrhythmias (17% vs 30%, p = 0.045). Complete resolution of symptoms of palpitations was significantly more common with ranolazine than placebo (31/53 vs 16/52 patients, p = 0.008). Also, portable ECG recordings showed that arrhythmias were less common during ranolazine vs. placebo, with significant decreases in number (7 ± 10 episodes/30 days vs. 23 ± 29 episodes/30 day, p = 0.001) and duration (10 ± 18 min/ 30 days vs. 19 ± 21 min/30 day, p = 0.021) of symptomatic arrhythmic episodes. No severe side effects were recorded during the trial period. Conclusion: The antianginal and antiischemic properties of ranolazine are paralleled by significant decreases in the occurrence of both arrhythmias and the related symptoms of palpitations in stable patients with IHD. (ClinicalTrials.gov identifier: NCT01495520).

Local delivery of thrombolytics before thrombectomy in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention — The DISSOLUTION randomized trial

Background: Ranolazine decreases the frequency of arrhythmias during the acute phases of ischemic heart disease (IHD), but it remains unknown if it has similar effects in the chronic phase of the disease. We performed a prospective, randomized, cross-over pilot trial to test the hypothesis that chronic treatment with ranolazine can reduce the incidence of documented arrhythmias and the related symptoms of palpitation in stable patients with IHD. Methods: We randomized 105 patients with stable IHD and symptoms of angina and palpitations already on therapy with betablockers and/or calcium antagonists to ranolazine (750 mg bid, N = 53) or placebo (N = 52) for 30 days (until T-1). After a washout period to avoid any carryover effect, cross-over was performed,and patients were switched to the other drug which was continued for 30 days (until T-2). All patients underwent symptomlimited exercise stress testing and 48-hour ECG Holter monitoring at T1 and T2. During the study period, patients were told to use a OmronN® portable ECG monitor HCG-801 device in case of symptoms of palpitations. Results: Ranolazine reduced the number of anginal episodes more commonly than placebo (5 ± 8 episodes/30 days vs. 21 ± 24 episodes/30 day, p = 0.001) and increased exercise durations at 1 mm ST-segment depression (514 ± 211 s vs. 402 ± 287 s, p = 0.025) and at onset of angina (614 ± 199 s vs. 519 ± 151 s, p = 0.007) at stress testing. These effects were coupled by significant decreases with ranolazine as compared with placebo treatment periods in the occurrence of frequent (N1000 beats) supraventricular arrhythmias (33% vs 52%, p = 0.01) and complex ventricular arrhythmias (17% vs 30%, p = 0.045). Complete resolution of symptoms of palpitations was significantly more common with ranolazine than placebo (31/53 vs 16/52 patients, p = 0.008). Also, portable ECG recordings showed that arrhythmias were less common during ranolazine vs. placebo, with significant decreases in number (7 ± 10 episodes/30 days vs. 23 ± 29 episodes/30 day, p = 0.001) and duration (10 ± 18 min/ 30 days vs. 19 ± 21 min/30 day, p = 0.021) of symptomatic arrhythmic episodes. No severe side effects were recorded during the trial period. Conclusion: The antianginal and antiischemic properties of ranolazine are paralleled by significant decreases in the occurrence of both arrhythmias and the related symptoms of palpitations in stable patients with IHD. (ClinicalTrials.gov identifier: NCT01495520).

Whole exome sequencing identifies the TNNI3K gene as a cause of familial conduction system disease and congenital junctional ectopic tachycardia

We report familial cardiac conduction disease (FCCD) in a 3-generation pedigree, including some family members with congenital junctional ectopic tachycardia (JET) (Fig. 1A). The proband presented during a febrile illness at 3.5-years of age with variable atrio-ventricular (AV) block (1st, 2nd, and 3rd degrees) together with left anterior fascicular block (LAFB) and right bundle branch block (RBBB) (Fig. 1B). Viral studies and echocardiogram were normal and he received a pacemaker; he subsequently developed clinical junctional tachycardia. Family history revealed a maternal grandmother with RBBB diagnosed at 5 years of age. The electrocardiogram (ECG) from the proband's mother revealed sinus rhythm (SR), 1st degree AV block and a nonspecific intraventricular conduction delay. Clinical genetic testing of SCN5A did not reveal any disease-associated mutations. Subsequently she gave birth to identical twin girls. Both girls had rapid JET in the immediate post-natal period that was initially difficult to control. There was rate dependent RBBB and LAFB in both children prior to use of antiarrhythmic drugs. The arrhythmia has resolved in one twin but persists in the other as a catecholamine dependent accelerated junctional rhythm/congenital JET that is modified by propranolol therapy (Fig. 1C). The resting ECGs now both show LAFB and intermittent incomplete RBBB. The mother has subsequently developed symptomatic palpitations and shows electrocardiographic features consistent with typical atrioventricular nodal re-entrant tachycardia (AVNRT) on symptom-rhythm correlation observed on loop recorder. Thus, the conduction defects in this family were of varying severity and the relationship to congenital JET in the three children is important as it is well recognized that congenital JET may progress to heart block [ 1 Henneveld H. Hutter P. Bink-Boelkens M. et al. Junctional ectopic tachycardia evolving into complete heart block. Heart. 1998; 80: 627-628 Crossref PubMed Scopus (23) Google Scholar , 2 Villain E. Vetter V.L. Garcia J.M. et al. Evolving concepts in the management of congenital junctional ectopic tachycardia. A multicenter study. Circulation. 1990; 81: 1544-1549 Crossref PubMed Scopus (211) Google Scholar ]. At this stage the conduction abnormalities are minor in the twins who presented with the JET and have not progressed.

The risk and severity of developing symptomatic palpitations when prescribed mirabegron for overactive bladder

ObjectivesMirabegron is a new selective β3-adrenoreceptor agonist licensed for the treatment of overactive bladder (OAB). In clinical trials, mirabegron is well-tolerated with a low side-effect profile. There is little data available on the risks in a non-selected population. The presence of β-adrenoreceptors in cardiac and vascular tissue leads to the possibility of the development of adverse cardiovascular events. We conducted a consecutive cohort study to assess the risk of developing palpitations, the severity of the condition and to investigate any underlying risk factors that predispose patients with OAB to develop palpitations whilst taking mirabegron. Study designA consecutive cohort of patients with OAB was studied between February 2013 and June 2014. Patients were prescribed mirabegron 50mg daily and outcomes assessed at 6 weeks. Patients with known cardiac arrhythmias were excluded. In patients who developed palpitations, a detailed account of their symptoms and medical history were documented and a 12-lead electrocardiogram (ECG) was performed to assess heart rate, QT interval and the presence of any persisting arrhythmia was conducted. ResultsA total of 279 patients were started on mirabegron. Eight patients (2.9%) reported palpitations whilst taking the drug. Two patients with a history of palpitations with no history of prolonged QT interval or arrhythmia on ECG developed worsening palpitations. The QTc was prolonged in two patients at 0.458 and 0.441s (QTc <420). Three patients developed chest pain or tightness. The palpitations resolved once therapy was stopped and did not result in serious adverse events such as hospitalisation. ConclusionsPalpitations in an unselected population have a similar incidence to that demonstrated in previous drug trials. Palpitations may be associated with a worsening of cardiovascular dysfunction.

Giant Coronary Aneurysm Secondary to Coronary-Atrial Fistula

A 29-year-old woman with no history of heart disease presented with symptoms of palpitations and chest congestion after activity for 1 month. On physical examination, she had a precordium continuous murmur. Findings on electrocardiography were normal. Chest radiography in the posteroanterior view

Coupling Interval Ratio Is Associated with Ventricular Premature Complex-Related Symptoms.

Background and ObjectivesFrequent ventricular premature complex (VPC) is one of the most common arrhythmia syndromes. Symptoms observed frequently with this arrhythmia syndrome remain limited. We sought to identify predictors of VPC-related symptoms by analyzing demographic information, VPC burden, and VPC surface electrocardiogram characteristics.Subjects and MethodsWe prospectively enrolled 109 patients with idiopathic outflow tract VPCs (63 males, 49±16 years old). They were divided into Group A (n=30, without VPC-related symptoms of palpitations or "dropped beats") and Group B (n=79, with VPC-related symptoms). Measured parameters were sinus and VPC QRS width, coupling interval (CI) between the previous sinus beat and VPC, CI ratio (%, CI/sinus cycle length), post-VPC CI and CI ratio, and VPC amplitude.ResultsBoth groups had similar age (p=0.22), daily VPC burden (p=0.15), and VPC site of origin (p=0.36). The VPC CI ratio was higher in Group B (60±15%) than in Group A (49±22%) (p=0.01).ConclusionVPC-related symptoms are associated with a higher VPC CI ratio (>50%). The physiologic basis for these results deserves further study.

ELEMENT INTOXICATION BY MARINE FOOD

Abstract Introduction: Pollution is deformation of natural condition of earth with physical, chemical and biological factors. Environmental pollution suppress life balance and has negative effect on living and ecosystem with its effects on the food chain. Toxic metal pollution easily enters to food chain and accumulate in the living body. Marine species are intensely exposed to toxic metals, because of its habitats and feeding habits, and metals accumulate in their body. Case: A 56 year-old obese male patient attended to Ortakent-Yahsi Family Health Center (Bodrum, Mugla, Turkey) with the symptoms of palpitation, constipation, long-term muscle contraction in January 2014. VEGA test resulted in toxic load accumulation. The pre-treatment and inter-treatment blood / serum levels of a group of trace / toxic elements were measured with Inductively Coupled Plasma Optical Emission Spectrometer (ICP - OES) at Istanbul University Cerrahpasa Medical Faculty, Biophysics Department. Neural therapy and chelation therapy were initiated to the patient by his doctor at Yahsi Family Health Center in February 2014. Conclusion: There is limited data related with the trace / toxic contamination of marine food in humans. The evaluation of trace and toxic elements might have significant value in diagnosis, treatment and follow-up of the individuals in contaminated environment and especially in seafood consumers. Key words: Marine food, trace element, toxicity, VEGA test, chelation therapy.

용안육(龍眼肉) 물추출물이 대식세포의 염증반응과 Cytokine에 미치는 영향

Objectives: The purpose of this study was to investigate the effects of Longanae Arillus water extract (LA) on the production of inflammatory mediators in RAW 264.7 cell. LA is used for forgetfulness, insomnia, palpitation symptoms in korean medicine. Methods: In order to evaluate cytotoxicity of LA, cell viability was measured. To investigate anti-inflammatory effects of LA in the lipopolysacharide (LPS)-induced RAW 264.7 cell, the concentration of nitric oxide (NO) and cytokines were measured. And when p-value is below 0.05, it is judged to have the significant difference statistically. Results: 1. LA showed no cytotoxicity. 2. LA inhibited significantly the production on NO at the concentration of 50 and <TEX>$200{\mu}g/ml$</TEX>. 3. LA inhibited significantly the production on interleukin (IL)-<TEX>$1{\beta}$</TEX> at the concentration of 25, 50, 100 and <TEX>$200{\mu}g/ml$</TEX>. 4. LA inhibited significantly the production on tumor necrosis factor (TNF)-<TEX>${\alpha}$</TEX> at the concentration of 50, 100 and <TEX>$200{\mu}g/ml$</TEX>. 5. LA inhibited significantly the production on lipopolysaccharide-induced chemokine (LIX) at the concentration of 25, 100 and <TEX>$200{\mu}g/ml$</TEX>. 6. LA inhibited significantly the production on regulated on activation normal T cell expressed and secreted (RANTES) at the concentration of <TEX>$200{\mu}g/ml$</TEX>. Conclusions: These results suggest that LA has anti-inflammatory effect.

Utility of extended cardiac monitoring to detect atrial fibrillation in patients with severe obstructive sleep apnea.

The relationship between obstructive sleep apnea (OSA) and increased risk for atrial fibrillation (AF) has been well established in previous studies. The relationship between OSA and silent AF is unknown. We hypothesized that patients with OSA but no known history of AF are at an increased risk for the arrhythmia and may be detectable by prolonged electrocardiogram (ECG) monitoring. In this study, we examined whether 7days of extended cardiac monitoring with an ECG event recorder is an effective screening tool to detect intermittent, silent AF in patients with severe OSA. The study was a prospective observational study. Randomly chosen patients with newly diagnosed severe OSA, apnea-hypopnea index (AHI) ≥ 30, were included. Demographic, medical history, and sleep data were collected. Patients with a history of AF or symptoms of palpitations were excluded from participating. Seven consecutive days of ambulatory ECG event recording (with Model ER920W, eCardio, Houston, TX) were performed prior to the initiation of CPAP treatment. A total of 20 subjects, with a BMI of 38.8 ± 12.2, successfully completed the study. The mean age group was 52.6 ± 12.6years and mean AHI 63.5 ± 29.2. The majority of subjects (70%) had no abnormal cardiac rhythms detected. AF lasting for 7s was seen in one subject, and paroxysmal atrial tachycardia lasting for 3.6s was seen in another. Clinically relevant AF was not detected in any of the subjects. In patients with severe OSA without a known history of AF, 7days of extended cardiac monitoring with an ECG event recorder did not detect clinically meaningful, silent AF.

Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias

BackgroundMany patients report symptoms of palpitations or dizziness/presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness/presyncope.MethodsDesign: prospective, observational, cross-sectional study. Setting: Clinical Physiology, University Hospital. Patients: 108 consecutive patients referred for ambiguous palpitations or dizziness/presyncope. Interventions: All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG (Zenicor EKG® thumb) recordings at home, twice daily and when having cardiac symptoms, during 28 days. Main outcome measures: Significant arrhythmias: atrial fibrillation (AF), paroxysmal supraventricular tachycardia (PSVT), atrioventricular (AV) block II–III, sinus arrest (SA), wide complex tachycardia (WCT).Results95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation (AF) in two patients and atrioventricular (AV) block II in one patient (= 3.2% relevant arrhythmias [95% CI 1.1–8.9]). Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia (PSVT) and one with AV-block-II (= 13.7% relevant arrhythmias [95% CI 8.2–22.0]). There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias (P = 0.0094). With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia episodes.ConclusionsIntermittent short ECG recording during four weeks is more effective in detecting AF and PSVT in patients with ambiguous symptoms arousing suspicions of arrhythmia than 24-hour Holter ECG.

Simulation of Intraoperative Pacemaker Failure

Simulation of Intraoperative Pacemaker Failure

The prognostic implications of lack of palpitations in patients hospitalised with atrial fibrillation: observations from a 20-year registry

It is well recognised that patients differ in the clinical presentation of atrial fibrillation (AF), ranging from the typical symptom of palpitations, atypical symptoms in others and a substantial that are asymptomatic. Whether the different patterns of presentation are associated with differences in outcomes is not known. The aim of this study was to evaluate the prevalence and the prognostic implications of lack of palpitations among patients hospitalised with AF in a large prospective registry. Retrospective analysis of all patients hospitalised with AF in Qatar from 1991 to 2010 was made. Patients were divided into two groups according to the presence or absence of palpitations on presentation. Clinical characteristics and outcome were analysed. During the 20-year period, 3850 patients were hospitalised for AF; 1724 (44.8%) had palpitations on presentation while 2126 (55.2%) had no palpitations. Patients who lacked palpitations were 9 years older, had a higher prevalence of diabetes mellitus (64.7% vs. 35.3%), underlying coronary artery disease (CAD; 14.6% vs. 6.2%) and severe left ventricular dysfunction on echocardiography (25.5% vs. 6.6%), (all, p = 0.001). There were 141 deaths among the group with no palpitations compared with 19 among the group with palpitations (6.6% vs. 1.1%). Multivariate analysis of mortality predictors identified 'lack of palpitations' as an independent predictor of in-hospital mortality (relative risk 5.56; 95% confidence interval 1.20-25.0, p = 0.03). Our study demonstrates for the first time that lack of palpitations as the presenting symptom of patients with AF is associated with worse in-hospital outcome independent of other risk factors or therapy. The underlying mechanisms and the role of confounders warrant further investigation.

ERACEing the Risk of Cerebral Embolism From Atrial Fibrillation Ablation

Atrial fibrillation (AF) is the most common arrhythmia requiring treatment. The adverse outcomes commonly attributed to AF include symptomatic palpitations, dyspnea and exertional intolerance, and increased risk of thromboembolic complications, especially stroke. Because of the morbidity of this condition, several different treatment strategies have been derived to improve patient outcome. One of the strategies that are being used increasingly is catheter ablation. Presently, this is an aggressive, extensive ablation procedure designed to isolate triggering foci from electric conduction to the body of the atria and modifying atrial substrate to disrupt or prevent conduction/propagation of reentrant wave fronts. This procedure can be of long duration and associated with extensive myocardial destruction. Most of the ablation is performed in the systemic circulation. Because of these factors, systemic embolic events, especially stroke, have always been feared complications associated with this procedure.1 Although the prevalence of stroke complications has been low, concern has been raised in recent years about the observation of asymptomatic cerebral embolism (ACE) on diffusion-weighted MRI.2–4 Article see p 835 ACE lesions after catheter ablation of AF were first reported by Lickfett et al5 and since have been described by several groups. The mechanisms leading to the formation of ACE lesions have not been completely elucidated but are presumed to be because of microembolism to the small terminal intracerebral arteries.1 The components of the microembolic material causing ACE lesions after AF catheter ablation are hypothesized to be thrombus, gas microbubbles, heat-denatured albumin microbubbles, thermal coagulum, and avulsed tissue.6 Because this procedure does not involve catheter manipulation in the aortic root or aortic valve, dislodged calcium and cholesterol plaque probably do not have a role in ACE lesion production as …

Local delivery of thrombolytics before thrombectomy in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention - the dissolution randomized trial

Background: Ranolazine decreases the frequency of arrhythmias during the acute phases of ischemic heart disease (IHD), but it remains unknown if it has similar effects in the chronic phase of the disease. We performed a prospective, randomized, cross-over pilot trial to test the hypothesis that chronic treatment with ranolazine can reduce the incidence of documented arrhythmias and the related symptoms of palpitation in stable patients with IHD. Methods: We randomized 105 patients with stable IHD and symptoms of angina and palpitations already on therapy with betablockers and/or calcium antagonists to ranolazine (750 mg bid, N = 53) or placebo (N = 52) for 30 days (until T-1). After a washout period to avoid any carryover effect, cross-over was performed,and patients were switched to the other drug which was continued for 30 days (until T-2). All patients underwent symptomlimited exercise stress testing and 48-hour ECG Holter monitoring at T1 and T2. During the study period, patients were told to use a OmronN® portable ECG monitor HCG-801 device in case of symptoms of palpitations. Results: Ranolazine reduced the number of anginal episodes more commonly than placebo (5 ± 8 episodes/30 days vs. 21 ± 24 episodes/30 day, p = 0.001) and increased exercise durations at 1 mm ST-segment depression (514 ± 211 s vs. 402 ± 287 s, p = 0.025) and at onset of angina (614 ± 199 s vs. 519 ± 151 s, p = 0.007) at stress testing. These effects were coupled by significant decreases with ranolazine as compared with placebo treatment periods in the occurrence of frequent (N1000 beats) supraventricular arrhythmias (33% vs 52%, p = 0.01) and complex ventricular arrhythmias (17% vs 30%, p = 0.045). Complete resolution of symptoms of palpitations was significantly more common with ranolazine than placebo (31/53 vs 16/52 patients, p = 0.008). Also, portable ECG recordings showed that arrhythmias were less common during ranolazine vs. placebo, with significant decreases in number (7 ± 10 episodes/30 days vs. 23 ± 29 episodes/30 day, p = 0.001) and duration (10 ± 18 min/ 30 days vs. 19 ± 21 min/30 day, p = 0.021) of symptomatic arrhythmic episodes. No severe side effects were recorded during the trial period. Conclusion: The antianginal and antiischemic properties of ranolazine are paralleled by significant decreases in the occurrence of both arrhythmias and the related symptoms of palpitations in stable patients with IHD. (ClinicalTrials.gov identifier: NCT01495520).

Left ventricular hemangioma

A young Saudi woman presented with symptoms of palpitation, near syncope, anxiety, and fatigue. Transthoracic echocardiography showed a left ventricular mass. Under cardiopulmonary bypass, brief cardioplegic arrest, and the aid of a thoracoscope, the mass was resected. Histologic examination showed a rare benign cardiac tumor: mixed cavernous-capillary hemangioma.

Low prevalence of Brugada-type electrocardiogram in a prospective large cohort of Egyptians

Abstract Background Brugada syndrome is a cardiac channelopathy that is associated with a high risk of VF and SCD and characterized by ECG pattern of transient or persistent, coved type ST-segment elevation in leads V 1 – V 3 . Aim To prospectively determine the prevalence of Brugada-type ECG pattern (Brugada sign) among unselected non cardiac individuals served at Cairo university teaching-hospital. Methods This study was conducted from October 2011 to September 2012, and included 4000 unselected noncardiac individuals (2078 males 52%, mean age 39 ± 14.44 years) admitted or presented to our hospital for different reasons. A 12-lead ECG was recorded for each of them; these ECGs were reviewed independently by two electrophysiologists for criteria of the three types of Brugada ECG pattern, and diagnosis of Brugada sign was made when both investigators agreed on the classification of the ECG findings according to the criteria of the Consensus Report of the Study Group of the Molecular Basis of Arrhythmia of the European Society of Cardiology. Results Twenty-two (0.55%) subjects had Brugada ECG pattern. All of them were of Mediterranean ethnic group. 18 males (0.45%), and 4 females (0.1%). No subjects showed type-1, while 11 (0.275%) of the 22 subjects had type-2, and the other 11 had type-3 Brugada ECG pattern. Eight cases (0.2%) among the 22 subjects were between 10 and 24 years old. Of the 22 subjects, 4 cases (18.2%) were symptomatic (palpitation and syncope), and 3 cases (13%) had positive F.H of SCD. Conclusion The frequency of type-1 Brugada-type ECG pattern was 0%, while type-2 and type-3 (saddleback type) was 0.55% among Egyptian hospital-based population, and it was more prevalent in middle-aged males.

The right recommendations for the wrong reasons?

This editorial is endorsed by the Belgium Heart Rhythm Association (BeHRA) and the Belgian Society of Cardiology (BSC), and refers to ‘Effectiveness of catheter ablation of atrial fibrillation in Belgian practice: a cohort analysis on administrative data’ by Van Brabandt et al ., on page 663. The mission of a health technology assessment (HTA) consists of advising public authorities when they have to take decisions on health care and health insurance, in particular concerning new technologies. Health technology assessment reports are based on a comprehensive review of literature and the analysis of national data. These data are interesting because of the large sample size and the absence of reporting bias introduced by selective publication of results from specialized centres. Health technology assessment reports put forward recommendations to the authorities and this can lead to crucial decisions about the reimbursement and potential availability of a technique. Recently, the KCE, the Belgian Health Care Knowledge Centre, published a HTA report on catheter ablation of atrial fibrillation (CA-AF).1,2 Upon the publication of their report (https://kce.fgov.be), the authors issued a press release in which they stated unambiguously: ‘catheter ablation for a benign arrhythmia: less effective than hoped’. In this editorial, we discuss about the legitimacy and the potential implications of this conclusion. Atrial fibrillation is not a benign condition, as it is associated with increased stroke, hospitalization, and death. In younger patients, it can lead to a marked impairment of quality of life (QoL) due to symptoms of palpitations, dyspnoea, and fatigue. From its start, CA-AF has offered the promise to free patients of symptomatic AF.3 Numerous randomized controlled trials (RCTs), performed in young patients with paroxysmal AF, compared a ‘strategy of CA-AF’ (i.e. a policy of initial pulmonary vein isolation with a repeat isolation if appropriate) to antiarrhythmic drugs.4 …

Management of symptomatic Wolff–Parkinson–White syndrome in childhood

The term “ventricular preexcitation” or “preexcitation” refers to the presence of a delta wave and short PR interval on electrocardiogram (ECG) during normal sinus rhythm. The Wolff–Parkinson–White (WPW) syndrome refers to preexcitation during sinus rhythm, in association with episodes of supraventricular tachycardia (SVT). The delta wave represents extra-nodal conduction via an accessory connection located along the atrioventricular groove or the septal region, and this substrate can support atrioventricular reentrant tachycardia. Patients with Wolff–Parkinson–White syndrome may experience symptoms of palpitations, dizziness, syncope, or sudden cardiac arrest related to supraventricular tachycardia; infants may present with congestive heart failure. Catastrophic symptoms such as cardiac arrest or sudden death may be triggered from atrial fibrillation with rapid antegrade conduction to the ventricle via the accessory connection, resulting in ventricular fibrillation [1–4]; this risk is likely higher in patients in the first three decades of life [4,5]. Sudden cardiac arrest as the initial symptom may be more common in younger patients [2,4,6]; for this reason, appropriate evaluation and management of the young patient with preexcitation is essential.

Implantable Loop Monitors

Symptomatic palpitations and passing-out spells, otherwise known as syncope, are 2 of the most common presentations to emergency departments and cardiology outpatient offices. Heart rhythm abnormalities, or cardiac arrhythmias, can be the reason some people experience recurrent palpitations, dizziness, or even syncope. These events can be episodic with no clear triggers, hence making diagnosis difficult and frustrating for patients and their providers. Cardiac arrhythmias can result from abnormally slow heart rates, fast heart rates, or even profound pauses in the heart rate attributable to electric disease and short-circuits of the electric circuitry of the heart. For years, the mainstay in diagnosing heart rhythm abnormalities has been hospital or outpatient monitoring from home via monitors placed on the chest wall that record the heart rhythm. Typically, these monitors can be worn anywhere from 24 hours up to 30 days. Continuous looping monitors can automatically record heart rhythms that reach a programmed threshold of slow or fast heart rate, even without the need for the patient to push any buttons to manually record. Nonlooping monitors are best suited for patients with sustained episodes that last ≥1 minute. These monitors have no wires or adhesive patches. The monitor is placed against the chest wall, and with the press of a button manual recordings of the heart rhythm can be made. Unfortunately, the yield of these approaches can be limited by compliance issues in wearing the adhesive patches or difficulty sleeping while wearing bulky monitors, with limited yield if no symptoms or events are noted during the timeframe of monitoring. An implantable …