ABSTRACT
The interplay between neurology and cardiology has gained significant attention in recent years, particularly regarding the shared pathophysiological mechanisms and clinical comorbidities observed in epilepsy and arrhythmias. Neuro-cardiac electrophysiology mapping involves the comprehensive assessment of both neural and cardiac electrical activity, aiming to unravel the intricate connections and potential cross-talk between the brain and the heart. The emergence of artificial intelligence (AI) has revolutionized the field by enabling the analysis of large-scale data sets, complex signal processing, and predictive modeling. AI algorithms have been applied to neuroimaging, electroencephalography (EEG), electrocardiography (ECG), and other diagnostic modalities to identify subtle patterns, classify disease subtypes, predict outcomes, and guide personalized treatment strategies. In this review, we highlight the potential clinical implications of neuro-cardiac mapping and AI in the management of epilepsy and arrhythmias. We address the challenges and limitations associated with these approaches, including data quality, interpretability, and ethical considerations. Further research and collaboration between neurologists, cardiologists, and AI experts are needed to fully unlock the potential of this interdisciplinary field.
ABSTRACT
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is underdiagnosed and requires comprehensive angiographic findings. Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome (TTS) or exist simultaneously, making it challenging for clinicians to treat and manage. Case reports lack consolidated data. We examined SCAD-TTS case reports. AIM: To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS. METHODS: SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed, EMBASE, Scopus, and Google Scholar databases till January 2023. Case reports described demographics, comorbidities, imaging, management, and results. RESULTS: Twelve articles about 20 female patients were analyzed. 30% of patients (n = 6, > 60 years) were elderly (mean age 56.2 ± 9.07 years, range 36-70 years). Canada has 9 cases, United States 3, Australia 3, Sweden 2, Japan, Denmark, and France 1. Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS. Nine had hypertension, 2 had hyperlipidemia, and 1 had prediabetes. 5 patients (25%) smoked. 10 (50%) troponin-positive myocardial infarction patients reported chest discomfort. 11 (55%) of 20 instances had TTS/SCAD. 12 (60%) of 20 patients exhibited ST elevation and 3 (15%) had T wave inversion on electrocardiogram. 19/20 patients had elevated troponin. 9 (45%) of 20 people had apical akinesis with TTS ballooning on cardiac imaging. All 20 exhibited echocardiographic wall motion abnormalities. 19 (95%) of 20 coronary angiography cases had SCAD. 10 of 19 SCAD patients had left anterior descending, 2 diagonal, and 2 left circumflex coronary artery involvement. 7 of 20 patients had left ventricular ejection fraction (LVEF) data. LVEF averaged 38.78 ± 7.35%. 5 (25%) of the 20 cases underwent dual antiplatelet therapy. Three (15%) of 20 cases experienced occasional ectopic ventricular complexes, Mobitz ll AV block, and paroxysmal atrial fibrillation. All 20 cases recovered and survived. CONCLUSION: Given the clinical similarities and challenges in detecting TTS and SCAD, this subset needs more research to raise awareness and reduce morbidity.
ABSTRACT
Atrial fibrillation (AF) is the most persistent arrhythmia today, with its prevalence increasing exponentially with the rising age of the population. Particularly at elevated heart rates, a functional abnormality known as cardiac alternans can occur prior to the onset of lethal arrhythmias. Cardiac alternans are a beat-to-beat oscillation of electrical activity and the force of cardiac muscle contraction. Extensive evidence has demonstrated that microvolt T-wave alternans can predict ventricular fibrillation vulnerability and the risk of sudden cardiac death. The majority of our knowledge of the mechanisms of alternans stems from studies of ventricular electrophysiology, although recent studies offer promising evidence of the potential of atrial alternans in predicting the risk of AF. Exciting preclinical and clinical studies have demonstrated a link between atrial alternans and the onset of atrial tachyarrhythmias. Here, we provide a comprehensive review of the clinical utility of atrial alternans in identifying the risk and guiding treatment of AF.
