Clinical Evidences and Pathophysiology of Cardiac Arrhythmia in the Era of Coronavirus Disease-2019.

The coronavirus disease-2019 (COVID-19) is primarily caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been a challenge to the clinician. Epidemiological studies unveiled the involvement of the cardiovascular system during the course of SARS-CoV-2 infection. The cardiac complications in patients with COVID-19 include myocarditis, heart failure, acute coronary syndrome, and cardiac arrhythmia. The pathophysiological states of the disease and multiple concurrent medications (unfamiliar to the clinicians) lead to a significant threat to arrhythmia. This review article hopes to elucidate the mechanisms of arrhythmias in COVID-19.

New Technologies for Detection and Management of Atrial Fibrillation.

Atrial fibrillation (AF) is a common and prevalent form of arrhythmia. It is associated with various morbidities with stroke being the major hazard. Since AF is often reported to be asymptomatic, many individuals remain unaware of their condition and may not receive the requisite treatment. Hence, screening for AF has gained substantial attention recently. Growing advancement in technology has paved way for numerous approaches for AF screening using medical-prescribed devices as well as consumer electronic devices. However, there still lies scope for large-scale randomized trials which would explore additional aspects associated with AF. This review very concisely summarizes AF, screening, present technology, current literature and clinical studies associated with it.

Spontaneous Coronary Artery Dissection in Relation to Physical and Emotional Stress: A Retrospective Study in 4 Arab Gulf Countries.

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome and sudden cardiac death. The triggers for SCAD often do not include traditional atherosclerotic risk factors. The most commonly reported triggers are extreme physical or emotional stress. The current study compared in-hospital and follow-up events in patients with SCAD with and without reported stress. Data from 83 patients with a confirmed diagnosis of SCAD were collected retrospectively from 30 centers in 4 Arab Gulf countries (KSA, UAE, Kuwait, and Bahrain) from January 2011 to December 2017. In-hospital myocardial infarction (MI), percutaneous coronary intervention (PCI), ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, ICD placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) events were compared between those with and without reported stress. Emotional and physical stress was defined as new or unusually intense stress, within 1 week of their initial hospitalization. The median age of patients in the study was 44 (37-55) years. Foty-two (51%) were women. Stress (emotional, physical, and combined) was reported in 49 (59%) of all patients. Sixty-two percent of women with SCAD reported stress, and 51 % of men with SCAD reported stress. Men more commonly reported physical and combined stress. Women more commonly reported emotional stress (P < 0.001). The presence or absence of reported stress did not impact on overall adverse cardiovascular events (P = 0.8). In-hospital and follow-up events were comparable in patients with SCAD in the presence or absence of reported stress as a trigger.

ß-Blockers on Discharge From Acute Atrial Fibrillation Are Associated With Decreased Mortality and Lower Cerebrovascular Accidents in Patients With Heart Failure and Reduced Ejection Fraction.

The benefits of ß-blockers in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) are controversial. The Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department (ED). We studied the incidence of 6- and 12-month mortality, hospitalization for HF or AF, and stroke/transient ischemic attacks (TIAs) in patients with HFrEF, in relation to ß-blockers on discharge from the ED or the subsequent hospital stay. Of the 344 patients with HFrEF and AF in the GULF-SAFE, 177 patients (53%) were discharged on ß-blockers. Mortality was lower in those patients compared with the non-ß-blockers group at 6 and 12 months (odds ratios [ORs] 0.31, 95% CI [0.16-0.61]; OR 0.30, 95% CI [0.16-0.55]; P = .001 for both, respectively), so was the risk of stroke/TIAs. However, hospitalizations for AF increased in the ß-blockers group. Even after adjustment for several risk variables in 2 different models, the beneficial effect of ß-blockers on mortality persisted, at the cost of more hospitalization for AF.