Seasonal variation in cardiac conductive disorders in Egyptian patients

To evaluate seasonal variation in cardiac conductive disorders leading to permanent pacemaker implantation. Conductive disorders of all patients who had implanted cardiac pacemakers during the period from January 2007 to end of March 2009 were evaluated. All conduction disorders in atrial and atrio-ventricular node were included. Statistical analysis was done by SPSS version 13. 627 patients, 346 males and 281 females were included in the study divided into multiple age groups. We recorded seasonal variability in the incidence of conductive disorder with two peaks in months march and June i.e. at the end of winter and end of spring. incidence of conduction disorders which lead pacemaker implantation was higher at the end of Winter and the end of Spring than other seasons. This recorded observation opens the discussion about the etiology and provocation in cardiac conductive disorders

Left atrial appendage function in patients with nonrheumatic atrial fibrillation

In this study, 36 patients with non-rheumatic AF and 10 healthy subjects were investigated. The patients were subjected to thorough history taking, thorough clinical examination, plain X-ray chest to assess the cardiothoracic ratio and pulmonary vasculature, 12-lead surface ECG to define the patient's rhythm, rate and type of AF [course or fine], transthoracic echocardiographic examination and transesophageal echocardiography. The flow pattern of all patients and normal subjects was assessed by transesophageal pulsed wave and color Doppler and two distinct flow patterns were recorded [low flow pattern in 18 patients and high flow pattern in 18 patients]. This study confirmed that LAA is a highly contractile dynamic pump with a pattern of contraction that is quite distinct from that of the main body of the LA. LAA thrombus formation is associated with LAA dilatation, decreased LAA EF percentage and slow forward and backward velocity

Should all patients with unexplained paroxysmal palpitations undergo diagnostic electrophysiologic study [EPS]

This study was performed on 40 patients for the evaluation of palpitations. There were 17 patients with inappropriate sinus tachycardia diagnosed with an elevated resting heart rate and an exaggerated heart rate response to exercise in the absence of organic illness, they were excluded from the study. The other 23 patients [16 females and 7 males] were diagnosed as paroxysmal unexplained palpitations. All patients had careful history taking, cardiac exam and baseline labs including complete blood count and thyroid functions. Also, they had regular 12-lead ECG, echocardiography, 24-Holter monitoring and exercise test. All patients underwent baseline electrophysiologic studies in a drug- free state of anti- arrhythmic medicine. Atrial and ventricular stimulation protocol using up to three extrastimuli was done as well as using Isuprel infusion if no tachycardia was induced at baseline. The study concluded that palpitation is a common symptom that needs a careful work-up to assess the etiological diagnosis. Electrophysiological studies in these patients have a low yield and should be only considered in patients with documented sustained arrhythmia or highly suspicious for rhythm disorder