Efficacy and safety of semaglutide in patients with heart failure with preserved ejection fraction and obesity.

BACKGROUND: Semaglutide, a once-weekly glucagon-like peptide-1 receptor agonist, has shown promise in weight management and cardiovascular outcomes in other populations. This study aimed to evaluate the efficacy of semaglutide in heart failure with preserved ejection fraction (HFpEF) patients with obesity. METHODS: A retrospective study analyzed 318 patients with HFpEF, of which 104 received semaglutide and 214 received placebo. Primary endpoints included evaluating changes in exercise capacity and weight management. RESULTS: Semaglutide treatment led to significant improvements in the primary endpoints. Patients in the semaglutide group demonstrated substantial enhancements in exercise capacity, as measured by the 6-min walk distance, compared to the placebo group (mean difference 15.1 meters, 95% CI 5.8 to 24.4, p = 0.002). Additionally, semaglutide resulted in substantial weight loss compared to placebo (mean difference -2.9%, 95% CI -4.1--1.7, p = 0.001). Several secondary endpoints, including reductions in C-reactive protein levels and improvements in other clinical parameters, further supported the efficacy of semaglutide. Adverse events were generally well-tolerated, with no unexpected safety concerns. CONCLUSION: Semaglutide demonstrated significant clinical benefits in HFpEF patients with obesity, as evidenced by improved symptoms, physical function, and weight reduction.

Gender Disparity in Work Distribution Among Cardiology Trainees: Pakistan's Perspective.

Gender disparity in work distribution among cardiology trainees is a crucial issue that can impact career development and the overall representation of women in the field. This cross-sectional survey aimed to examine the gender disparity in work distribution among cardiology trainees in Pakistan. A total of 1156 trainees from various medical institutions across the country participated in the study, with 687 male trainees (59.4%) and 469 female trainees (40.5%). Demographic characteristics, baseline characteristics, work distribution patterns, perceptions of gender disparity, and career aspirations were assessed. The findings revealed that male trainees reported being assigned more complex procedures compared to female trainees (75% vs 47%, P < 0.001), while female trainees reported a higher frequency of being assigned administrative tasks compared to male trainees (61% vs 35%, P = 0.001). Both genders reported similar perceptions of the overall workload. However, female trainees experienced significantly higher rates of perceived bias and discrimination compared to male trainees (70% vs 25%, P < 0.001). Moreover, female trainees expressed a higher perception of unequal opportunities for career advancement due to gender disparities (80% vs 67%, P < 0.001). While male and female trainees showed similar aspirations for pursuing advanced subspecialties within cardiology, male trainees expressed a higher intention to pursue leadership positions within the field (60% vs 30%, P = 0.003). These findings shed light on the existing gender disparities in work distribution and perceptions within cardiology training programs in Pakistan.

Strategies for the Long-Term Preservation of Site for Future Implantation of Cardiac Implantable Electronic Devices (CIEDs): Two Decades of Experience.

Introduction Implantation of cardiac implantable electronic devices (CIEDs) is an art of science. As the volume of implantation has increased worldwide, so has the rate of complications. Infection, fibrosis, lead and device erosion, lead displacement, right ventricle perforation, lead fracture, and insulation break are the common complications in the implantation process. This exposes the patient for reopening and threatens the implantation for further complication due to infection, fibrosis of veins, failure to retrieve the implanted wire, and failure to re-implant the device on the same site. We slightly changed our implantation technique to preserve the implantation site for future implantation and reduce the rate of complication in the index implantation. Methods This randomized control trial was conducted from January 2016 to September 2019 at Hayatabad Medical Complex Peshawar, Pakistan. A consecutive sampling technique was used to obtain a sample size of 602 patients keeping a 95% confidence interval and a 5% margin error. We adopted a strategy to take prick, for implantation of devices, inside the pocket, which reduces the number of sutures, hastens the procedure, prevents erosion, and minimizes the chance of subclavian crush syndrome and insulation break. We also selected the minimum possible length of leads. This will possibly decrease the chances of cumbersome fibrosis around the lead and device and will make future implantation convenient. Results There was a total of 602 procedures in the study period. About 253 (42%) procedures were done in the newly adopted strategy and 349 (58%) were performed in the conventional way. Our complication rate grossly reduces in the novel way of implantation in which we took our prick inside the pocket. Conclusion A slight modification in the implantation of CIEDs not only prevents the rate of complication in the index implantation but will also possibly preserve the site for future implantation.

Implantation Of The Permanent Pacemaker; From Superior Vena Cava In A Patient With Fibrosis Of Both Subclavian Veins.

Overall life span has increased with improved management of cardiac diseases all over the world which has opened the door of degenerative cardiac diseases. On the other hand, stat of the art corrective congenital cardiac disease also increased the volume of adult living with treated congenital heart diseases. Both these factors lead to a new epidemic in cardiology of complete heart block (CHB). Permanent pacemakers (PPM) implantation is a life-saving procedure for CHB. Permanent pacemakers are usually implanted from upper limb veins. But at time upper limb veins are not suitable for implantation due to various anatomical and pathological reasons, so alternative methods are used for implantation of devices. We are reporting a case of PPM implantation from Superior Vena Cava (SVC).

Innovation in Permanent Pacemaker's Implantation Technique: Trans-Axillary Approach.

INTRODUCTION: Permanent pacemakers' (PPM) implantation is an integral part of electrophysiology and general cardiology. The implantation technique has evolved a lot since the first implantation. Several innovations have been undertaken to improve the effectiveness, life of the transplant, and patient outcomes. In this study, we introduced a new implantation technique to improve the procedure and possibly reduce the rate of complication. METHODS: This study was conducted from January 2016 to February 2017 in Hayatabad Medical Complex, Peshawar. Patients destined for implantation of PPM based on a clinical treatment plan, after proper explanation of the procedure, were brought to the catheterization laboratory. Venogram of the upper limb performed. Patients were scrubbed and draped. The axillary vein was approached via the Seldinger technique. About 2 to 3 cm superolateral to the puncture site, a skin incision was made and subcutaneous pocket constructed, and a guidewire external end was pulled in from inside the pocket keeping the venous end at the place. Subsequently, in a routine way, lead was placed, secured and the wound was closed in layers. RESULTS: A total of 690 PPM were implanted under the study. About 290 devices were implanted in the conventional way and 380 devices via the trans-axillary approach. The mean implantation time was less than 30 minutes via the trans-axillary approach. Immediate and delayed complications of the procedure were minimal. CONCLUSION: Trans-axillary approach holds some significant advantages over the conventional technique. The subcutaneous pocket and venous puncture successfully reduce the burden of foreign material, minimize the tension on the wound, shorten implantation time and reduce the chances of erosion of the device.

Cross Over: A Reliable Maneuver In The Confirmation Of Atrioventricular Nodal Reentrant Tachycardia Ablation.

BACKGROUND: Atrioventricular nodal re-entrant tachycardia (AVNRT) is still the most common presentation to our electrophysiology laboratory for ablation. The aim of this study is to document the confirmative value of cross over manoeuvre in successful AVNRT ablation. METHODS: This study was conducted in Hayat Abad Medical complex Peshawar June 2006 to October 2015. In all patient with AVNRT, Dual-nodal pathway physiology confirmed by programmed atrial pacing of eight Tran with an extra beat by 10 millisecond (ms) decrement and at least Atrial HIS (A-H) interval prolongation of 50 ms. The dual pathway was further confirmed by cross over manoeuvre. Slow pathway potential identified and radiofrequency ablation (RFA) energy applied at 60 temperatures and 30 powers in Left Anterior Oblique (LAO) projection. Post ablation absence of cross over documented with and without isoproterenol and patient followed for any complication or recurrence. RESULTS: Total 567 patients studied with mean age 36.56±12.16 and male to female ratio 1:1.4 with presentation of supraventricular tachycardia (SVT). Slow pathway was successfully modified and statistically no significant complication or recurrence documented. CONCLUSIONS: Failure to cross over reliably excludes any conduction over the slow pathway and so recurrence of AVNRT.

Localization Of Accessory Pathway In Patients With Wolff-Parkinson-White Syndrome From Surface Ecg Using Arruda Algorithm.

BACKGROUND: To ablate accessory pathway successfully and conveniently, accurate localization of the pathway is needed. Electrophysiologists use different algorithms before taking the patients to the electrophysiology (EP) laboratory to plan the intervention accordingly. In this study, we used Arruda algorithm to locate the accessory pathway. The objective of the study was to determine the accuracy of the Arruda algorithm for locating the pathway on surface ECG. METHODS: It was a cross-sectional observational study conducted from January 2014 to January 2016 in the electrophysiology department of Hayat Abad Medical Complex Peshawar Pakistan. A total of fifty nine (n=59) consecutive patients of both genders between age 14-60 years presented with WPW syndrome (Symptomatic tachycardia with delta wave on surface ECG) were included in the study. Patient's electrocardiogram (ECG) before taking patients to laboratory was analysed on Arruda algorithm. Standard four wires protocol was used for EP study before ablation. Once the findings were confirmed the pathway was ablated as per standard guidelines. RESULTS: A total of fifty nine (n=59) patients between the age 14-60 years were included in the study. Cumulative mean age was 31.5 years±12.5 SD. There were 56.4% (n=31) males with mean age 28.2 years±10.2 SD and 43.6% (n=24) were females with mean age 35.9 years±14.0 SD. Arruda algorithm was found to be accurate in predicting the exact accessory pathway (AP) in 83.6% (n=46) cases. Among all inaccurate predictions (n=9), Arruda inaccurately predicted two third (n=6; 66.7%) pathways towards right side (right posteroseptal, right posterolateral and right antrolateral). CONCLUSIONS: Arruda algorithm was found highly accurate in predicting accessory pathway before ablation.