Characterization of suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy

Differences in the quantity and distribution of coronary veins between patients with ischemic and non-ischemic cardiomyopathy might affect the potential for the left ventricular [LV] lead targeting in patients undergoing cardiac resynchronization therapy [CRT]. In the current study, we assessed and compared the suitability of the coronary venous system for the LV lead placement in ischemic and dilated cardiomyopathy. This single-centre study, performed at our hospital, retrospectively studied 173 patients with the New York Heart Association class III or IV who underwent CRT. The study population was comprised of 74 patients with an ischemic underlying etiology and 99 patients with a non-ischemic etiology. The distribution of the veins as well as the final lead positions was recorded. There was no significant difference between the two groups in terms of the position of the available suitable vein with the exception of the posterior position, where the ischemic group had slightly more suitable veins than did the dilated group [48.4% versus 32.1%, p value - 0.049]. There was also no significant difference with respect to the final vein, through which the LV lead was inserted. Comparative analysis showed that the patients with previous coronary artery bypass grafting surgery [CABG] had significantly fewer suitable veins in the posterolateral position than did the non-CABG group [16.3% versus 38.7%, p value = 0.029]. There was, however, no significant difference between the two subgroups regarding the final vein position in which the leads were inserted. The final coronary vein position suitable and selected for the LV lead insertion was not different between the cases with cardiomyopathy with different etiologies, and nor was it different between the ischemic cases with and without a history of CABG. Patients with a history of procedures around the coronary vessel may have an intact or recovered venous system and may, therefore, benefit from transvenous LV lead placement for CRT

Elevated serum visfatin levels in patients with acute myocardial infarction

Visfatin, a novel adiopocytokine, has been proven to be a proinflammatory mediator involved in the process of atherosclerosis. Visfatin has been shown to play a role in plaque destabilization as it is found abundantly in foam cell macrophages within unstable atherosclerotic plaques. The present study is designed to investigate the potential association between serum vistafin levels and the risk of acute myocardial infarction [AMI]. There were 72 patients [mean age: 61.57 +/- 11.40 years] as cases who presented with first-time AMI that were assessed 8 hours after the incident. The control group consisted of 83 healthy volunteers [mean age: 60.30 +/- 8.32 years]. Plasma visfatin levels were measured using enzyme immunoassay in both groups. Biochemical parameters were analyzed. Blood pressure, body mass index [BMI], waist circumference, diabetes, and hypertension were recorded. Serum visfatin levels were significantly higher in patients with AMI [12.77 +/- 8.06 ng/ml] compared to controls [6.57 +/- 2.96 ng/ml, P 7.244 ng/ml [log visfatin > 0.86] had a sensitivity of 70% and a specificity of 75% for predicting AMI. We have detected high levels of visfatin in patients with AMI. It can be concluded that proinflammatory cytokines such as visfatin may play a role in the development of atherosclerosis as well as destabilization of the atherosclerotic plaque

Persian, last 7-day, long form of the international physical activity questionnaire; translation and validation study

To translate long form, interview-administered International Physical Activity Questionnaire [IPAQ] from English to Persian and evaluate its validity, reliability and reproducibility. A forward-backward translation procedure was followed to develop the Persian version of the IPAQ. A total of 218 respondents [53.7% women, aged 22-76 yr] completed the Persian version in Tehran, Iran. To examine the test-retest reliability, 48 healthy volunteers completed the IPAQ twice during a 7-day period. The PA indicators derived from the IPAQ were assessed for reliability and were compared with aerobic fitness and body mass index [BM1] for construct validity. n general, the questionnaire was received well and all domains met the minimum reliability standards [intra-class correlation [ICC]> 0.7], except for Leisure-time physical activity [PA]. Aerobic fitness showed a weak positive correlation with all of the PA results derived from the IPAQ. A significant correlation was observed between the IPAQ data for total PA and both aerobic fitness [r=0.33, P<0.001] and BMI [r=0.26, P<0.001]. Performing a known group comparison analysis, the results indicated that the questionnaire was discriminated well between the subgroups of the study samples expected to be different in their physical activity. The Persian version of the long form, interview-administered IPAQ had an acceptable reliability and validity for assessing total PA in our Iranian sample of individuals. It may be a useful instrument for generating internationally comparable data on PA

Pre-participation cardiovascular screening of elderly wrestlers

Sudden death of a competitive athlete is a tragedy that is usually caused by a previously unsuspected cardiovascular disease. The aim of this study was to clarify the role of noninvasive testing in pre-participation cardiovascular evaluation of elderly wrestlers. We included 63 Iranian elderly wrestlers who participated in Tehran international elderly wrestlers' preparation camping by census method. A questionnaire including past medical and family history as well as coronary risk factors was filled out and then a complete physical examination of the cardiovascular system was done by an internist for all wrestlers. Electrocardiogram [ECG], complete echocardiographic examination and then symptom limited exercise test were performed and reported by the cardiologists who did not know the other examinations results. Exertional dyspnea and typical chest pain [FC=I or II] were present in 5% and 1.7% of the examinees, respectively. There were one or more risk factors in 64.5% of the cases. Cardiovascular examination revealed abnormal heart sounds in 27.1%. ECG showed ischemic changes in 13.6% and premature atrial contractions and premature ventricular contraction in 11.4%. echocardiography showed mild left ventricular systolic dysfunction in 3.4%, regional wall motion abnormality in 8.5%, valvular disease in 32.3%, diastolic dysfunction in 45.7%, and left ventricular hypertrophy in 16.9% of the cases. Exercise test results were negative, equivocal, positive and highly positive in 70.4%, 15.8%, 5.2%, and 8.6% of cases, respectively. Beside physical examination, pre-participation screening of elderly wrestling athletes with ECG and exercise testing is feasible and recommended in the presence of coronary risk factors or cardiac symptoms. Echocardiography can also be recommended to detect other relevant abnormalities when there is a clue in the standard history, physical examination or ECG

Ablation of focal right upper pulmonary vein tachycardia using retrograde aortic approach

The use of diagnostic and therapeutic methods for assessing pulmonary vein due to its status as a main source of ectopic beats for the initiation of atrial dysrrythmias is strongly recommended. We report the case of a 13-year-old girl who was admitted to our hospital with the electrocardiogram manifestation of an ectopic atrial tachycardia. The focus of arrhythmia was inside the right upper pulmonary vein. The patient underwent successful ablation with a conventional electrophysiology catheter via the retrograde aortic approach. We showed that when the origin of atrial tachycardia is in the right upper pulmonary vein, it is possible to advance the catheter into this vein via the retrograde aortic approach and find the focus of arrhythmia. This case demonstrates that right upper pulmonary vein mapping is feasible through the retrograde aortic approach and it is also possible to ablate the arrhythmia using the same catheter and approach

Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia: success rates and complications during 14 years of experience

Radiofrequency catheter ablation [RFCA] has been introduced as the treatment of choice for supraventricular tachycardia. The aim of this study was to evaluate the success rate as well as procedural and in-hospital complications of RFCA for the treatment of atrioventricular nodal reentrant tachycardia [AVNRT]. Between March 1995 and February 2009, 544 patients [75.9% female, age: 48.89 +/- 13.19 years] underwent 548 RFCAs for AVNRT in two large university hospitals. Echocardiography was performed for all the patients before and after the procedure. Electrocardiograms were recorded on digital multichannel systems [EP-Med] or Bard EP system. Anticoagulation was initiated during the procedure. From the 548 patients, 36 had associated arrhythmias, atrial flutter [4%], atrial fibrillation [0.7%], concurrent atrial fibrillation and atrial flutter [0.7%], and concealed atrioventricular pathway [0.4%]. The overall success rate was 99.6%. There were 21 [3.9%] transient III-degree AV blocks [up to a few seconds] and 4 [0.7%] prolonged II-or III-degree AV blocks, 2 [0.25%] of which required permanent pacemaker insertion, 3 [0.5%] deep vein thrombosis, and one [0.2%] arteriovenous fistula following the procedure. No difference was observed in the echocardiography parameters before and after the ablation. RFCA had a high success rate. The complication rate was generally low and in the above-mentioned centers it was similar to those in other large centers worldwide. Echocardiography showed no difference before and after the ablation. The results from this study showed that the risk of permanent II or III-degree AV block in patients undergoing RFCA was low and deep vein thrombosis was the second important complication. There was no risk of life-threatening complications