Reduction In Mean Heart Rate Research Articles

Effectiveness of different doses of dexmedetomidine on intraoperative haemodynamic profiles and postoperative pain in patients undergoing abdominal surgery at Dilla University Referral Hospital, Ethiopia, 2024: a double-blind randomized controlled trial.

Abdominal surgery stands as one of the most frequently conducted procedures across surgical specialties, accounting for up to half of surgery-related expenses. Hemodynamic instability emerges as a significant concern during anaesthesia and surgery, provoked by the stress of intubation, surgical incision, and anaesthetic agents. Following abdominal surgery, pain is an inevitable consequence, typically managed with opioid-based analgesia. However, the adverse effects associated with opioids often overshadow their analgesic benefits, particularly in the context of abdominal surgery. Consequently, there exists a necessity to explore and assess alternative non-opioid pain management options post-abdominal surgery as part of a broader strategy to reduce opioid usage. The primary aim of this investigation is to assess the effectiveness of varying doses of dexmedetomidine in regulating intraoperative hemodynamics and alleviating postoperative pain in patients undergoing abdominal surgery. Ethical clearance and institutional review board were obtained from the ethical clearance committee of Dilla University College of Medicine and Health Sciences with protocol unique number of duirb/008/22-01. Our trial has been prospectively registered on the Pan African Clinical Trial Registry with a unique identification number for the registry PACTR202208813896934. Statistical package and analysis were performed by using SPSS version 25. The distribution of data was checked by using Shapiro-Wilk test and the homogeneity of variance was checked by Levene's test. Analysis of variance (ANOVA) and Kruskal-Wallis H test were used for normally distributed continuous data and non-normally distributed or non-parametric data, respectively. P value less than 0.05 with a power of 90% was considered statistically significant. There was a statistically significant increase in mean SBP in the control group at the different critical time points (P<0.05), as compared to the baseline value, while there was no significant difference in mean systolic blood pressure (SBP) between the baseline and all other levels for group 2 and group 3. A statistically significant increase in mean arterial pressure (MAP) was detected in the control group at immediately after intubation (P=0.009) as compared to the baseline value, while a statistically significant reduction in mean heart rate (HR) was observed in group 3 at 15th min after infusion and at 30th 30 min after induction compared to baseline with a P value of 0.002 and 0.008, respectively.Conclusion:Perioperative low-dose infusion of dexmedetomidine at the rate of 0.4mcg/kg/h is a useful anaesthesia adjuvant to control hemodynamic stress response to critical periods. It is wise to use this infusion dose as part of general anaesthesia to achieve better hemodynamic stability.

The Effect of Er:YAG Laser Therapy in Combination with Behaviour Management Technique on the Reduction of Anxiety in Paediatric Dental Patients

This study aimed to evaluate the anxiety in paediatric patients during caries treatment, with Er:YAG laser and conventional rotary instruments, in combination with child-management technique Latent inhibition. A group of 126 6–12-year-old children with one or more untreated dentine carious lesions (ICDAS code 05) on the occlusal surface of a primary molar was divided into four equal treatment subgroups. A standardized caries treatment was performed with Erbium:YAG laser or conventional rotary instruments. In the intervention groups, Latent inhibition was used as an anxiety-management technique. During the procedure, objective and subjective stress parameters were recorded. Statistically significant reduction in mean heart rate and self-anxiety scores was seen in the combination of Er:YAG laser caries removal and child-management technique (p &lt; 0.05). The use of laser cavity preparation in combination with the child-management technique Latent inhibition is the most effective method during the dental treatment of children. Er:YAG laser alone showed an advantage over the conventional method and equivalent effect to the combined use of conventional rotary instruments and behaviour management technique.

Intravenous Landiolol for Rate Control in Supraventricular Tachyarrhythmias in Patients with Left Ventricular Dysfunction: A Systematic Review and Meta-Analysis.

Background: This systematic review explores the effects of landiolol administration in individuals presenting with supraventricular tachyarrhythmia (SVT) and concurrent left ventricular dysfunction, without being septic or in a peri-operative period. Methods: We systematically searched PubMed, Cochrane, Web of Science, and Scopus databases, retrieving a total of 15 eligible studies according to prespecified eligibility criteria. Results: Patients treated with landiolol experienced a substantial reduction in heart rate (HR) (mean HR reduction: 42 bpm, 95% confidence intervals (CIs): 37-47, I2 = 82%) and were more likely to achieve the target HR compared to those receiving alternative antiarrhythmic therapy (pooled odds ratio (OR): 5.37, 95% CIs: 2.87-10.05, I2 = 0%). Adverse events, primarily hypotension, occurred in 14.7% of patients receiving landiolol, but no significant difference was observed between the landiolol and alternative antiarrhythmic receiving groups (pooled OR: 1.02, 95% CI: 0.57-1.83, I2 = 0%). No significant difference was observed between the two groups concerning sinus rhythm restoration (pooled OR: 0.97, 95% CI: 0.25-3.78, I2 = 0%) and drug discontinuation due to adverse events (pooled OR: 5.09, 95% CI: 0.6-43.38, I2 = 0%). Conclusion: While further research is warranted, this systematic review highlights the potential benefits of landiolol administration in the management of SVTs in the context of left ventricular dysfunction.

A COMPARATIVE STUDY OF MEPHENTERMINE AND PHENYLEPHRINE IN THE TREATMENT OF HYPOTENSION DURING SPINAL ANAESTHESIA FOR CAESAREAN SECTION

Purpose: To compare the effects of mephentermine and phenylephrine in maintaining arterial blood pressure in patients undergoing caesarean section under spinal anaesthesia who develop hypotension. Materials and method- This randomized study consisted of 42 parturient women who underwent elective caesarean section under spinal anaesthesia and developed hypotension during the operation. The patients were equally divided into 2 groups: Group I &amp; Group II. Participants in Group I received intravenous bolus of Phenylephrine 100 mcg whereas participants in Group II received intravenous bolus of Mephentermine 6 mg. Mean heart rate, systolic blood pressure (SBP), diastolic (DBP) and mean arterial pressure (MAP) were measured at baseline and then at 2 minutes intervals till 10th minute and thereafter at every 5 minutes till 30th minute and then at 45th, 60th, 75th, 90th and 120th minute. Results- Mean heart rate, SBP, DBP and MAP were comparable at baseline in both the groups. The reduction in mean heart rate after administration of a vasopressor was statistically signicant in Group I in comparison with Group II. Both Mephentermine &amp; Phenylephrine were efcacious in maintaining the SBP, DBP and MAP within the normal range i.e., 20% of the baseline value and no statistically signicant difference was observed between them. Both the vasopressors, Mephentermine and Phenylephrine have s Conclusion- imilar efcacy in maintaining post spinal maternal hypotension during caesarean section, although Phenylephrine causes reduction in heart rate which can be advantageous in patients with undesirable tachycardia. In addition to this, both the groups had no signicant adverse effects.

Hybrid epicardial and endocardial sinus node–sparing ablation therapy for inappropriate sinus tachycardia: Rationale and design of the multicenter HEAL-IST IDE trial

Inappropriate sinus tachycardia (IST) is defined as resting heart rate >100 beats/min and average 24-hour heart rate >90 beats/min. It is associated with distressing symptoms and significant loss of quality of life. Drugs are not effective in symptom control of IST in up to 30% of patients. Catheter ablation of the sinus node has a high recurrence rate, and the complications are significant. Recently, a novel hybrid sinus node-sparing ablation approach for IST was described. The objective of the Hybrid Epicardial and Endocardial Sinus Node Sparing Ablation Therapy for Inappropriate Sinus Tachycardia (HEAL-IST) investigational device exemption trial (NCT05280093) is to evaluate safety and effectiveness of the hybrid sinus node-sparing ablation procedure for the treatment of symptomatic, drug-refractory or drug-intolerant IST. The HEAL-IST trial is a prospective, multicenter, pivotal, single-arm trial. Up to 142 subjects in up to 40 centers will be treated in the trial with a Bayesian adaptive design. Subjects will be assessed for primary safety through 30 days post-hybrid ablation procedure. The primary effectiveness endpoint will be freedom from IST at 12 months. Freedom from IST will be defined as mean heart rate of ≤90 beats/min or at least a 15% reduction in mean heart rate as compared with baseline, in the absence of new or higher dosage of previously failed medications at a 24-month follow-up assessment. The HEAL-IST trial is the first multicenter trial evaluating hybrid IST ablation in patients with symptomatic IST and refractory or intolerant to drugs. The results of this study will help guide decision making regarding the best management in this population.

Effect of pharmacological interventions for the treatment of people with post‐COVID‐19 condition: A rapid review

AbstractObjectiveLittle is known about the treatment of post‐coronavirus disease 2019 (COVID‐19) condition (PCC). This article examines the effectiveness of pharmacological interventions for treating people with PCC.MethodsWe searched Medline, EMBASE, ClinicalTrials. gov, and the International Clinical Trials Registry Platform. Two independent review authors screened citations, extracted data, and assessed the quality of the included studies. Due to heterogeneity in participants, interventions, and outcomes, we synthesized data narratively. We assessed the certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation).ParticipantsPeople with PCC.InterventionsPharmacological interventions include corticosteroids, ivabradine, and inhaled hydrogen.Outcome MeasuresOlfactory function, sinus tachycardia, respiratory function.ResultsWe identified 5 completed studies and 41 ongoing studies. Oral corticosteroids and olfactory training had higher olfactory scores after 10 weeks (MD: 5.60, 95% confidence interval [CI]: 1.41 to 9.79). Patients allocated oral corticosteroid, and nasal irrigation demonstrated improved recovery of olfactory function compared with the control group at 40 days (median 60, interquartile range [IQR]: 40 vs. median 30, IQR: 25, p = 0.024). Patients allocated to topical corticosteroid nasal spray and olfactory training had improved recovery of olfactory function after 2 weeks (median 7, IQR: 5−10 vs. median 5, IQR: 2−8, p = 0.08). Participants allocated to ivabradine had a greater mean reduction in heart rate compared with participants randomized to carvedilol (MD: −4.24, 95% CI: −10.09 to 1.61). Participants allocated to inhaled hydrogen therapy had an improved vital capacity (MD: 0.20, 95% CI: 0.07 to 0.33), forced expiratory volume (MD: 0.19, 95% CI: 0.04 to 0.34), 6‐minute walk test (MD: 55.0, 95% CI: 36.04 to 73.96).ConclusionsThe evidence is of low to very low certainty about the effect of all pharmacological interventions investigated for the treatment of people with PCC. There is currently a significant body of research underway that could expand the evidence to inform treatment decisions on pharmacological interventions for PCC.

Real-World Effectiveness of Ivabradine in Chinese Patients with Chronic Heart Failure: Interim Analysis of the POSITIVE Study.

BackgroundIvabradine improves cardiac function and clinical outcomes in chronic heart failure (HF) by reducing heart rate (HR), but there is a lack of real-world data on its effectiveness and safety in Chinese patients.MethodsWe designed a prospective, multicenter, observational study of Chinese adults with HF and left ventricular systolic dysfunction, resting HR ≥ 75 beats per minute (bpm), and an indication for ivabradine treatment. An interim analysis was performed using a cut-off date of 31 October 2019. The primary outcome was change in HR at 6 months after the initiation of ivabradine. Secondary endpoints included change in New York Heart Association (NYHA) functional class; quality of life (QoL), measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ); and adverse events (AEs).ResultsOverall, 655 subjects were included in the interim analysis. Mean reduction in HR from baseline was 13.2 (95% confidence interval [CI] 11.2–15.2) bpm at Month 1, and 14.5 (95% CI 11.8–17.2) bpm at Month 6 (p < 0.001 for both changes). NYHA functional class and KCCQ scores improved significantly over time (p < 0.001 for all comparisons with baseline), indicating amelioration of symptoms and better QoL, respectively. Forty-four subjects (6.7%) reported a total of 60 ivabradine-related AEs, most frequently phosphenes and bradycardia (both n = 6, 0.9%).ConclusionTreatment with ivabradine for 6 months effectively reduced HR and improved functional class and QoL in Chinese patients with chronic HF. Treatment was well tolerated.Clinical Trial RegistrationISRCTN11703380; registered on 8 November 2016.

Efficacy and Safety of Remdesivir over Two Waves of the SARS-CoV-2 Pandemic.

The aim of this study is to describe the features, the outcomes, and the clinical issues related to Remdesivir administration of a cohort of 220 patients (pts) with COVID-19 hospitalized throughout the last two pandemic waves in Italy. One hundred and nine pts were enrolled from 1 September 2020, to 28 February 2021 (Group A) and 111 from 1 March to 30 September 2021 (Group B). Notably, no differences were reported between the two groups neither in the timing of hospitalization. nor in the timing of Remdesivir administration from symptoms onset. Remarkably, a higher proportion of pts with severe COVID-19 was observed in Group B (25% vs. 10%, p < 0.001). At univariate and multivariate analysis, rather than the timing of Remdesivir administration, age, presence of coexisting conditions, D-dimers, and O2 flow at admission correlated positively to progression to non-invasive ventilation, especially for patients in Group B. However, the rate of admission in the Intensive Care Unit and/or death was comparable in the two groups (7% vs. 4%). Negligible variations in serum GOT, GPT, GGT, and eGFR levels were detected. A mean reduction in heart rate was noticed within the first three days of antiviral treatment (p < 0.001). Low rate of ICU admission, high rate of clinical recovery, and good drug safety were observed in COVID-19 patients treated with Remdesivir during two diverse pandemic waves.

A songbird adjusts its heart rate and body temperature in response to season and fluctuating daily conditions.

In a seasonal world, organisms are continuously adjusting physiological processes relative to local environmental conditions. Owing to their limited heat and fat storage capacities, small animals, such as songbirds, must rapidly modulate their metabolism in response to weather extremes and changing seasons to ensure survival. As a consequence of previous technical limitations, most of our existing knowledge about how animals respond to changing environmental conditions comes from laboratory studies or field studies over short temporal scales. Here, we expanded beyond previous studies by outfitting 71 free-ranging Eurasian blackbirds (Turdus merula) with novel heart rate and body temperature loggers coupled with radio transmitters, and followed individuals in the wild from autumn to spring. Across seasons, blackbirds thermoconformed at night, i.e. their body temperature decreased with decreasing ambient temperature, but not so during daytime. By contrast, during all seasons blackbirds increased their heart rate when ambient temperatures became colder. However, the temperature setpoint at which heart rate was increased differed between seasons and between day and night. In our study, blackbirds showed an overall seasonal reduction in mean heart rate of 108 beats min-1 (21%) as well as a 1.2°C decrease in nighttime body temperature. Episodes of hypometabolism during cold periods likely allow the birds to save energy and, thus, help offset the increased energetic costs during the winter when also confronted with lower resource availability. Our data highlight that, similar to larger non-hibernating mammals and birds, small passerine birds such as Eurasian blackbirds not only adjust their heart rate and body temperature on daily timescales, but also exhibit pronounced seasonal changes in both that are modulated by local environmental conditions such as temperature. This article is part of the theme issue 'Measuring physiology in free-living animals (Part I)'.

463 The Effect of Intervention of Medical Staff on the Adherence of CPAP and Heart Rate in Patients with Obstructive Sleep Apnea

Abstract Introduction Recent studies have indicated that obstructive sleep apnea syndrome (OSAS) is associated with hypertension. OSA is a common cause of sympathetic nervous activity. Increase of sympathetic nervous activity causes hypertension. Continuous positive airway pressure (CPAP) is the most useful treatment for OSAS. Good CPAP adherence treatment improve the risk of hypertension. This study examined the effect of intervention of medical staff on the adherence of CPAP, heart rate and sleep stages in patients with OSA. Methods All patients diagnosed with OSA and undergoing subsequent CPAP were clinically followed for 12 months to examine CPAP adherence, as well as longitudinal changes in blood pressure, average heartrate of 24 hours and sleep stages. They were divided into 2 groups, Group A: patients who had individual consulted in person by sleep physician and technicians before start using CPAP and Group B: patents who did not have individual consulted. Patients in both groups were consulted by sleep physician and technicians after start CPAP with utilizing tele-monitoring. If the adherence were poor, the patients were recommended to stop CPAP. We provided 3D accelerometer and an optical pulse photoplethysmography to all the patients and analyzed the data of heart rate and sleep stages. Results A total of 30 OSA patients underwent CPAP, were enrolled in the study and assessed for changes in mean heart rate and body weight during the study period. We found a significant reduction in mean heart rate in both group A and B compared with baseline (p&amp;lt;-0.05). The patients aged under 50 years old and whose AHI&amp;lt;20 times/hour have higher ratio of dropout CPAP therapy. There was no significant difference between Group A and Group B on the persistency rate of CPAP therapy. Also, no significant association was found between group A and B on the adherence of CPAP. Conclusion We showed the importance of the effect of intervention of medical staff on the adherence of CPAP and heart rate in patients with OSA the consultation after starting CPAP for a while with utilizing tele-monitoring data would be more effective compared with that in person before start using CPAP. Support (if any):

High Dosage of Carvedilol is Effective to Induce Remodeling and Improve Survival in Children with Dilated Cardiomyopathy

Purpose We aim to evaluate clinical outcomes, echocardiographic changes, heart rate (HR) modifications and side effects in children with dilated cardiomyopathy (DCM) and chronic heart failure (HF) treated by high dosage of carvedilol. Methods We prospectively enrolled pediatric patients with DCM and ventricular dysfunction (EF 20% from baseline. Conventional treatment should be started from at least 1 month. Initial dosage of carvedilol was 0.1 mg/kg/day, up-titrated every 2 weeks to a maximum dose of 1 mg/kg/day. All data were compared to an historical control group treated with low dose of carvedilol or without beta-blockers. Data were collected before and after one year of maximum tolerated treatment. Results 65 patients (58% male) were enrolled, mean age was 13.4 +/- 9 years. 72 patients (48% male) were enrolled in the control group, mean age was 3.9 +/- 3.7. Mean duration of treatment was 50 months. HR reduction and EF improvement were statistically significant after treatment (mean HR reduction was 23%, p Conclusion High dosage of carvedilol up-titrated to achieve a reduction of heart rate of 20%, in addition to standard therapy, significantly improve ventricular function and survival in pediatric patients with DCM.

Ivabradine plus conventional treatment vs conventional treatment alone in reducing the mean heart rate in heart transplant recipients: A randomized clinical trial.

The absence of afferent nerves for heart rate (HR) regulation leaves the transplanted heart under the influence of its internal and hormonal control. The HR of heart transplantation (HTx) recipients varies from to 90-110bpm, indicating a lack of vagal parasympathetic tone. We hypothesized that the reduction in mean HR using an If-channel antagonist (ivabradine) could be effective and safe in HTx recipients. The primary objective of this open-label randomized clinical trial was to compare the mean HR at 3, 6, 12, 18, 24, 30, and 36months after randomization between an ivabradine plus conventional treatment group (IG) and conventional treatment alone group (CG). The secondary objectives were reduction in mortality, graft dysfunction, and ventricular mass. All patients were randomized between 1 and 12months after HTx. Ivabradine started at randomization. Of the 35 patients, 54.28% were in the CG and 45.72% in the IG. There were no significant between-group differences in demographics. Over time, the HR differences between the groups became significant (P<.01). There were no significant between-group differences in mortality, graft dysfunction, and ventricular mass. We conclude that ivabradine could effectively and consistently reduce the HR in HTx recipients.

Effect of hydrotherapy and yogic kriyas on snoring: A randomized control study

Introduction: Snoring is a common sleep disorder, considered as a cardinal symptom of obstructive sleep apnea. The present study aims to explore and substantiate the clinical effect of hydrotherapy with Yogic Kriyas in individuals with snoring. Methods: Randomized control trial, where 60 patients aged 30–55 years were recruited and were randomly allocated into case and control groups. Subjects were assessed for systolic and diastolic blood pressure (SBP, DBP), respiratory rate (RR), pulse rate (PR), epworth sleepiness scale, Berlin and Short Form-36 (SF-36) questionnaires, weight, body mass index (BMI), saturation of peripheral oxygen (SpO2), and heart rate variability (HRV) before and after 10 days of intervention. Results: In case group, there was a significant increase in the values of SF-36 scoring (P = 0.0002), SPO2 (P = 0.002), Berlin score (P = 0.0001) and a significant decrease in weight (P = 0.0001), BMI (P = 0.0001), Epworth questionnaire score (P = 0.0001), SBP (P = 0.0008), DBP (P = 0.0001), PR (P = 0.0001), and RR (P = 0.00) following the intervention. In time domain of HRV, there was significant reduction in mean heart rate (P = 0.0001). In frequency domain, a significant increase was observed in high frequency (HF) value (P = 0.043) and a significant reduction was observed in low frequency (LF) (P = 0.0001) and LF/HF Ratio (P = 0.0005). In control group, significant reduction was seen in weight, BMI (P = 0.0001), PR (P = 0.0001) and RR (P = 0.0001). Conclusion: Naturopathy intervention with Neutral throat pack, Neutral chest pack, Yogic Neti kriyas, Steam inhalation reduces sympathetic tone and shifts the sympathovagal balance in favor of parasympathetic dominance and claims that it can be effectively used in the management of snoring.

Ivabradine versus carvedilol in the management of palpitation with sinus tachycardia among recovered COVID-19 patients

Introduction: One of the major complications among COVID-19 patients include cardiac arrhythmias. Commonest arrhythmia is sinus tachycardia which is usually associated with palpitation causing discomfort to patients. In this study, we present a comparative study of use of Ivabradine vs. Carvedilol for sinus tachycardia in post-COVID-19 infected patients. Method: 50 consecutive recovered COVID-19 patients with sinus tachycardia were included in this open labelled RCT. 25 patients received Ivabradine and remaining 25 received Carvedilol. Single therapy non-responders were treated with Ivabradine with Atorvastatin. Results: The mean age of all patients is 48.8±7.66 years (Males 49.5 ± 7.21 years; Females 47.68 ± 8.23 years). The mean heart rate (MHR) of all patients is 125.52 ± 9.07/min (Males 125.67 ± 8.78/min; Females 125.26 ± 9.5/min). After five days of single drug therapy the mean drop in the heart rate was 35.04 ± 10.55/min (Males 34.41 ± 9.71/min; Females 36.05 ± 11.72/min), resulting in 27.88 ± 8.11% (Males 27.38 ± 7.56%; Females 28.69 ± 8.89%) reduction in MHR. Among the two groups, the Carvedilol group showed improvement of MHR in 14(56%) patients; whereas in Ivabradine group 18(72%) patients improved out of 25 patients each (p: 0.2385). In the Carvedilol group the MHR reduced from 128.6 ± 8.44 to 95.68 ± 10.63 (p &lt; 0.001), which is statistically significant; similarly, the Ivabradine group showed a MHR from 122.44 ± 8.62 to 85.28 ± 10.52 (p &lt; 0.001). The monotherapy therapy non-responders were treated with dual-therapy of (Ivabradine + Atorvastatin). Discussion: Ivabradine is more effective in controlling heart rate compared to Carvedilol. Also, Ivabradine group scores very well in ‘patient-satisfaction’ with regards to symptom (palpitation) relief. Conclusion: The COVID-19 sequelae of sinus tachycardia can be better controlled with Ivabradine when compared to Carvedilol.

ROLE OF HEART RATE REDUCTION WITH IVABRADINE IN LEFT VENTRICULAR FAILURE

Objective: To compare mean heart rate reduction in Ivabradine and placebo group in left ventricular failurepatients.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Study was conducted at CMH, Kharian, from Jul 2018 to Dec 2018.&#x0D; Methodology: 64 patients participated in the study. They were randomly divided into two groups of 32each. One group was given Tab Ivabradine (10 mg twice a day) while second group received a placebo for aperiod of 4 weeks. After 4 weeks each patient was evaluated and heart rate, systolic and diastolic blood pressure were recorded. Mann-whitney U test selected to compare heart rate and ages of both groups t- test used to compare systolic and diastolic blood pressure among both groups. Chi-square test used to determine the association of heart rate between two groups. A p-value ≤0.05 was considered significant.&#x0D; Results: Median (IQR) heart rate was significantly lower in Ivabradine group 58.3 (4) as compared to placebo64.1(1) (p&lt;0.01). Systolic blood pressure (132.8 ± 3.6) was significantly lower in ivabradine group as comparedto placebo group (137.1 ± 4.5) (p&lt;0.01). Difference in diastolic blood pressure was insignificant in both groups (p=0.55). There was a significant association between heart rate of 55-60 beats per minute and ivabradine use(p&lt;0.01).&#x0D; Conclusion: Ivabradine is safe and efficative drug in reducing heart rate and systolic blood pressure for patients suffering from left ventricular failure. Early detection and management of left ventricular failure with ivabradine use leads to better prognosis of the disease.

Comparison of incidence of oculocardiac reflex between hang-back and conventional rectus recession in horizontal strabismus surgery

To compare the incidence of oculocardiac reflex(OCR) between hang-back and conventional method of rectus muscle recession in horizontal strabismus.In this prospective, randomized, double blind study, 40 consecutive patients of horizontal strabismus were evaluated. The patients were randomized into two groups based on the type of surgical recession technique employed for squint correction. Twenty patients were operated by Hang-back technique (group-1) and 20 by conventional rectus muscle recession where the muscle tendon was sutured directly to the globe (group-2). All patients underwent pre-operative evaluation which included refraction, keratometry and assessment of angle of deviation etc. ECG was monitored before surgery. During surgery heart rate (HR) was recorded as heart rate baseline (HRB), after 5 minutes of intubation (HR5), during muscle traction (HRT), Minimum heart rate during traction of muscle (HRMin), Maximum increase in heart rate (HRMax). OCR was defined as &amp;#62; 20% reduction in HR during muscle traction as compared to baseline HR. Out of total 40 patients 17(42.50%) were having exotropia and 23 (57.50%) had esotropia. The overall incidence of OCR in conventional recession was found to be greater than that in hang-back recession. The mean baseline HR was 72.00± 7.391 beat/min in conventional recession group and 77.55± 7.494 beat/min in hang-back recession group. The mean HR reduction in conventional procedure was 56.05± 8.787 beat/min. and that in hang-back procedure 61.80 ± 9.317 beat/min., which was statistically significant (p&amp;#60;0.01). This was probably attributed to the shorter duration of surgery and lesser manipulation during surgery in hang-back as compared to conventional procedure. OCR is a common complication encountered during manipulation of muscle during strabismus surgery. Hang-back recession is a safe and effective method of muscle recession as it offers a shorter surgical time and better exposure along with lesser incidence of OCR with similar success rates when compared to conventional muscle recession.

Renal sympathetic denervation improves heart rate variability and reduces arrhythmia burden

Abstract Background Decreased heart rate variability (HRV) is a strong predictor of mortality (particularly sudden death), not only in high-risk patients. The impact of renal denervation (RDN) on HRV and cardiac arrhythmias has not yet been fully investigated. Purpose To assess the effect of RDN on HRV and cardiac arrhythmias in patients with blood pressure (BP) &amp;gt;160/100 mmHg despite 3 full-dose antihypertensive drugs. Methods The study included 108 patients (46.3% male) with resistant hypertension (RH), the average age was 50.5±9.0. All patients underwent RDN. Procedure was performed by an experienced electrophysiologist at the renal arteries using specialized electrode Symplicity Flex: ablation power = 8–10 W at 55°C, 4–10 points for each renal artery (including brunch, when was appropriate), 2 minutes per point. Office systolic BP (SBP) and diastolic BP (DBP), 24-hour ambulatory BP monitoring and 24-hour monitoring ECG were measured before, at 6 and 12 months of follow-up. Results Baseline SBP and DBP in these groups of patients were −185.6±29 and −110.5±19.3 mm Hg respectively. Office BP significantly decreased by −28.2±21.6 /18.0±16.7 mm Hg (p&amp;lt;0.001 for both) at 12 month. 24-hour SBP and DBP was significantly reduced both at 6 and 12 months after RDN. Twenty-four-hour BP was reduced by 13.2/8.4mmHg (P&amp;lt;0.001). The number and dosage of antihypertensive drugs remained unchanged in all patients. Baseline data of general HRV in this group of patients were low: SDNN – 123.4±41.4 msec. The general HRV increased at 12 month since RDN: SDNN from 123.4±41.4 msec to 155.8±51.4 msec (p&amp;lt;0.05), SDANN-i from 105.3±42.7 msec to 122.1±41.1 msec (p&amp;lt;0.05). There was observed increase in RMSSD, reflecting of parasympathetic activity of autonomic nervous system – from 29.7±43.6 msec to 41.1±33.2 msec (p&amp;lt;0.05). The total number of premature supraventricular and ventricular contractions was also significantly decreased both at 6 and at 12 months after RDN (p&amp;lt;0.05 for both cases). Mean 24-hour monitoring heart rate was reduced by 5.8 bpm (p=0.02) at 12 month after RDN. No pauses or conduction abnormalities were observed either at baseline or after RDN. Conclusions Besides the important effect of RDN on heart rate and arrhythmic events, a significant improvement the time domain indexes of HRV was evident in patients with resistant hypertension at 12 month after the RDN-procedure. Our prospective single center study shows that RDN results in substantial BP lowering, significant reduction of mean heart rate and arrhythmia burden and restores autonomic balance in patients with resistant uncontrolled hypertension. Funding Acknowledgement Type of funding source: None

High Dosage of Carvedilol is Effective to Induce Remodeling and Improve of Survival in Children with Dilated Cardiomyopathy

We aim to evaluate clinical outcomes, echocardiographic changes, heart rate (HR) modifications and side effects in children with dilated cardiomyopathy (DCM) and chronic heart failure (HF) treated by high dosage of carvedilol. We prospectively enrolled pediatric patients with DCM and ventricular dysfunction (EF <45%) referred to our institute. All enrolled patients were treated with high dosage of carvedilol coupled to heart failure therapy (ace inhibitors; diuretics, aldosterone blockade) in order to achieve a reduction of heart rate > 20% from baseline. Conventional treatment should be started from at least 1 month. Initial dosage of carvedilol was 0.1 mg/kg/day, up-titrated every 2 weeks to a maximum dose of 1 mg/kg/day. All data were compared to an historical control group treated with low dose of carvedilol or without beta-blockers. Data were collected before and after one year of maximum tolerated treatment. 65 patients (58% male) were enrolled, mean age was 13.4 +/- 9 years. 72 patients (48% male) were enrolled in the control group, mean age was 3.9 +/- 3.7. Mean duration of treatment was 50 months. HR reduction and EF improvement were statistically significant after treatment (mean HR reduction was 23%, p<0,0001; mean EF improvement 11,9%, p<0,0001); as well as decrease in LV diameters (p=0.001), volumes (p=0.029) and BNP levels (p=0.029) compared to control group. All patients survived, and 4 out of 4 were delisted from transplant list; on the contrary 32 patients of group 2 were transplanted and 11 died. Blood pressure remained stable for all patients treated with carvedilol and no side effects were recorded. High dosage of carvedilol up-titrated to achieve a reduction of heart rate of 20%, in addition to standard therapy, significantly improve ventricular function and survival in pediatric patients with DCM.

Once-Daily Netarsudil Versus Twice-Daily Timolol in Patients With Elevated Intraocular Pressure: The Randomized Phase 3 ROCKET-4 Study

To compare the intraocular pressure (IOP)-lowering efficacy and safety of netarsudil once daily (QD) and timolol twice daily (BID). Double-masked, randomized, phase 3, noninferiority study. Patients with open-angle glaucoma or ocular hypertension (unmedicated baseline IOP >20 to <30mm Hg at 8:00 AM) were randomized to netarsudil ophthalmic solution 0.02% QD (PM) or timolol ophthalmic solution 0.5% BID. The primary endpoint was mean IOP at 8:00 AM, 10:00 AM, and 4:00 PM at week 2, week 6, and month 3 in patients with baseline IOP <25mm Hg (per-protocol population). Safety was recorded over the 6-month treatment period. A total of 186 patients from each treatment arm were included in the primary efficacy analysis. Netarsudil QD met the criteria for noninferiority to timolol BID. Mean treated IOP ranged from 16.3 to 17.9mm Hg for netarsudil and 16.7 to 17.6 for timolol, with mean reductions from baseline of 3.9 to 4.7mm Hg and 3.8 to 5.2mm Hg, respectively. In prespecified secondary analyses, netarsudil demonstrated noninferiority to timolol in patients with baseline IOP <27mm Hg and <30mm Hg. The IOP-lowering effects of netarsudil were sustained over 6months of treatment. No treatment-related serious adverse event (AE) was reported for either study drug. However, statistically significant reductions in mean heart rate were recorded at all study visits for the timolol group. The most frequent ocular AE among netarsudil-treated patients was conjunctival hyperemia (47.9%), which was predominately mild. Netarsudil QD (PM), a first-in-class IOP-lowering medication, was noninferior to timolol BID and was associated with tolerable ocular AEs.

Electrocardiogram Changes of Donepezil Administration in Elderly Patients with Ischemic Heart Disease.

Objective Donepezil, a widely used cholinesterase inhibitor for treating Alzheimer's disease, has been reported to induce bradyarrhythmias and torsade de pointes. In this study, we aimed at determining electrocardiogram changes of donepezil administration in elderly patients with ischemic heart disease, who tend to suffer from cognitive disorders. Methods Sixty patients with ischemic heart disease and mild cognitive impairment were treated with donepezil (5 mg/day) and followed up for at least four weeks. A twenty-four-hour ambulatory electrocardiogram was performed for the analysis of heart rate variability. The ECG parameters including heart rate (HR), PR and RR intervals, QT interval, and QRS duration were recorded at the baseline and after donepezil administration. Results Donepezil administration resulted in significant reduction in mean HR and the lowest HR and prolongation of PR and RR intervals, whereas it had no significant effects on QRS duration and QT parameters including QT, corrected QT interval, QT dispersion, and Tpeak-end interval. HRV analysis showed that donepezil administration significantly improved parasympathetic function, indicated by decreased low/high frequency (LF/HF) ratio and high frequency (HF) components and oscillation of RR intervals. Conclusions These data demonstrated that donepezil administration decreased HR, prolonged PR interval, and increased parasympathetic function without affecting QRS duration and QT intervals, suggesting that it can be used safely in elderly patients with ischemic heart disease.