Search Our Scientific Publications & Authors

Heart Rhythm 2021 May 10. Epub 2021 May 10.

Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, USA. Electronic address:

Background: Interatrial septal tachycardias (IAS-AT) following atrial fibrillation (AF) ablation or cardiac surgery are rare and their management is challenging.

Objective: To investigate the electrophysiologic features and outcomes associated with catheter ablation of IAS-AT.

Methods: We screened 338 patients undergoing catheter ablation of ATs following AF ablation or cardiac surgery. Read More

Am J Case Rep 2021 May 10;22:e930732. Epub 2021 May 10.

Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.

BACKGROUND Tachycardia from atrial fibrillation or flutter can lead to left ventricular systolic dysfunction. Some patients deteriorate quickly, and there is an acute drop in their left ventricular systolic function; however, they tend to normalize rapidly after treatment of the underlying arrhythmia. The aim of publishing the present case is to maintain awareness that tachycardia is one of the etiologies of acute systolic heart failure, which is potentially reversible by treatment when recognized. Read More

World J Clin Cases 2021 May;9(13):3170-3176

Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.

Background: Perioperative stroke is a rare but devastating complication. The risk factors for massive cerebral stroke in surgical patients include older age, male sex, prior cerebrovascular disease, hypertension, renal failure, smoking, diabetes mellitus, and atrial fibrillation.

Case Summary: We describe two cases of perioperative massive cerebral stroke following thoracic surgery and one case following bronchoscopy. Read More

Cardiovasc Diagn Ther 2021 Apr;11(2):650-660

2nd Department of Internal Cardiovascular Medicine, General University Hospital, Prague, Czech Republic.

Fabry disease (FD) is an X-linked lysosomal storage disorder due to reduced or undetectable α-galactosidase A (AGAL-A) enzyme activity caused by pathogenic variants in the AGAL-A gene (). Tissue and organ changes are caused by widespread progressive accumulation of globotriaosylceramide (Gb) and globotriaosylsphingosine (lysoGb). The classical form of FD is multisystemic with cutaneous (angiokeratomas), neurological (peripheral neuropathy, premature stroke), renal (proteinuria and renal insufficiency), and cardiac involvement. Read More

Cardiovasc Diagn Ther 2021 Apr;11(2):529-537

Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.

The number of adults with congenital heart disease (ACHD) has increased over the last decades due to advancements in medical care, including interventional and surgical therapies. We are therefore more frequently challenged by the long-term consequences of palliative or corrective surgery carried out during childhood. Although patients with ACHD may develop conditions related to general cardiovascular risk factors, such as coronary artery disease, the most common complications leading to morbidity and mortality are arrhythmias, heart failure and thromboembolic events. Read More

J Stroke Cerebrovasc Dis 2021 May 4;30(7):105833. Epub 2021 May 4.

Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. Electronic address:

Objective: Vascular surgical procedures have one of the highest risks of perioperative stroke and stroke-related mortality, yet the independent risk factors contributing to this increased mortality have not been described. Perioperative strokes are thought to result from a combination of embolism and hypoperfusion mechanisms. The purpose of this study is to describe the independent predictors of perioperative stroke-related mortality in the vascular surgical population using the Pennsylvania Health Care Cost Containment Council (PHC4) database which collects cause of death data. Read More

CJEM 2021 May 18;23(3):314-324. Epub 2021 Jan 18.

Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.

Background: Acute atrial flutter has one-tenth the prevalence of acute atrial fibrillation in the emergency department (ED) but shares many management strategies. Our aim was to compare conversion from acute atrial flutter to sinus rhythm between pharmacological cardioversion followed by electrical cardioversion (Drug-Shock), and electrical cardioversion alone (Shock-Only).

Methods: We conducted a randomized, blinded, placebo-controlled comparison of attempted pharmacological cardioversion with IV procainamide followed by electrical cardioversion if necessary, and placebo infusion followed by electrical cardioversion. Read More

Crit Pathw Cardiol 2021 Apr 22. Epub 2021 Apr 22.

Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK School of Medicine, Keele University, Stoke-on-Trent, UK Department of Cardiology, Royal Devon and Exeter NHS Trust, Exeter, UK.

Chest pain is one of the most common reasons for patients to present to healthcare professionals. One of the main challenges with the management of chest pain is the wide differential diagnosis, ranging from minor chest trauma to potentially life threatening acute myocardial infarction. In a patient-centered health service pathway, the aim is to assess, investigate, diagnose and treat patients in the safest and most accurate, time and cost-efficient manner. Read More

Mayo Clin Proc 2021 05;96(5):1175-1183

Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ. Electronic address:

Objective: To evaluate the relationship between peripheral arterial disease (PAD) and incident atrial fibrillation (AF) and its clinical and pathophysiologic implications on ischemic stroke and all-cause mortality.

Patients And Methods: We identified all adult patients in the Mayo Clinic Health System without a previous diagnosis of AF undergoing ankle-brachial index (ABI) testing for any indication from January 1, 1996, to June 30, 2018. Retrospective extraction of ABI data and baseline echocardiographic data was performed. Read More

BMC Health Serv Res 2021 May 6;21(1):435. Epub 2021 May 6.

Sunnybrook Health Sciences Centre, University of Toronto, 890 Sheppard Avenue West, Ontario, M4N 3M5, Toronto, Canada.

Background/purpose: Interventional cardiac electrophysiology (EP) is a rapidly evolving field in Canada; a nationwide registry was established in 2011 to conduct a periodic review of resource allocation.

Methods: The registry collects annual data on EP lab infrastructure, imaging, tools, human resources, procedural volumes, success rates, and wait times. Leading physicians from each EP lab were contacted electronically; participation was voluntary. Read More

Int J Environ Res Public Health 2021 Apr 27;18(9). Epub 2021 Apr 27.

Department of Economics, University of Foggia, 71121 Foggia, Italy.

The purpose of this paper is to investigate the determinants influencing the costs of cardiovascular disease in the regional health service in Italy's Apulia region from 2014 to 2016. Data for patients with acute myocardial infarction (AMI), heart failure (HF), and atrial fibrillation (AF) were collected from the hospital discharge registry. Generalized linear models (GLM), and generalized linear mixed models (GLMM) were used to identify the role of random effects in improving the model performance. Read More

J Clin Med 2021 Apr 8;10(8). Epub 2021 Apr 8.

Infectious and Transplant Medicine Unit, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy.

The liver-heart axis is a growing field of interest owing to rising evidence of complex bidirectional interplay between the two organs. Recent data suggest non-alcoholic fatty liver disease (NAFLD) has a significant, independent association with a wide spectrum of structural and functional cardiac diseases, and seems to worsen cardiovascular disease (CVD) prognosis. Conversely, the effect of cardiac disease on NAFLD is not well studied and data are mostly limited to cardiogenic liver disease. Read More

Int J Environ Res Public Health 2021 Apr 6;18(7). Epub 2021 Apr 6.

School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan.

Although digoxin is important in heart rate control, the utilization of digoxin is declining due to its narrow therapeutic window. Misdiagnosis or delayed diagnosis of digoxin toxicity is common due to the lack of awareness and the time-consuming laboratory work that is involved. Electrocardiography (ECG) may be able to detect potential digoxin toxicity based on characteristic presentations. Read More

Sensors (Basel) 2021 Apr 5;21(7). Epub 2021 Apr 5.

Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool L1 8JX, UK.

The possibilities and implementation of wearable cardiac monitoring beyond atrial fibrillation are increasing continuously. This review focuses on the real-world use and evolution of these devices for other arrhythmias, cardiovascular diseases and some of their risk factors beyond atrial fibrillation. The management of nonatrial fibrillation arrhythmias represents a broad field of wearable technologies in cardiology using Holter, event recorder, electrocardiogram (ECG) patches, wristbands and textiles. Read More

Eur J Cardiovasc Nurs 2021 Apr;20(3):231-242

School of Nursing, The University of British Columbia, Canada.

Background: Atrial fibrillation is a complex condition associated with a broad spectrum of symptoms, coupled with variability in the frequency, duration and severity of symptoms. Early treatment seeking is important to reduce the risk of stroke, heart failure and dementia. Despite the increasing prevalence, there remains a limited understanding of the symptom experience prior to an atrial fibrillation diagnosis, and how these experiences influence treatment-related decisions and time frames. Read More

Emerg Med Pract 2021 May 1;23(5):1-28. Epub 2021 May 1.

Professor and George Kaiser Family Foundation Chair in Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK.

Atrial fibrillation is the most common dysrhythmia encountered in the emergency department. In patients aged >65 years, the incidence approaches 10%, and the number of patients with atrial fibrillation is expected to almost double in the next 30 years. Atrial fibrillation and its associated comorbidities also carry significant healthcare cost. Read More

Circulation 2021 Apr 22:CIR0000000000000973. Epub 2021 Apr 22.

The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. Read More

Medicine (Baltimore) 2021 Apr;100(16):e25437

Baoji People's Hospital, Baoji, Shanxi, China.

Background: Atrial fibrillation (AF) is the most common clinical arrhythmia and a major cause of morbidity and mortality in clinical practice. This study aims to determine the ranolazine for prevention and treatment of atrial fibrillation.

Method: This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols. Read More

BMJ Case Rep 2021 Apr 19;14(4). Epub 2021 Apr 19.

Division of Endocrinology, Diabetes, and Metabolism, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.

A 74-year-old woman with a history of primary hyperparathyroidism, thyroid nodules, atrial fibrillation and pacemaker placement for sick sinus syndrome presented with fatigue, constipation and persistent lower extremity oedema. She underwent subtotal parathyroidectomy and left thyroid lobectomy. Histopathology revealed amyloidosis affecting the thyroidand parathyroids confirmed by Congo Red Staining with Mayo Clinic subtyping of light chain kappa-type amyloidosis. Read More

Acta Chir Belg 2021 Apr 28:1-5. Epub 2021 Apr 28.

General Surgery Department, Royal Perth Hospital, Perth, Australia.

Introduction: Acute mesenteric ischemia (AMI) is a surgical emergency with a high mortality and morbidity rate. Prompt diagnosis and early surgical management are the cornerstones of management. In certain patients, however, treatment is futile and early palliative care, lessens patient, and family distress. Read More

Emerg Med Clin North Am 2021 May;39(2):323-338

Department of Surgery, Division of Emergency Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710, USA; Emergency Department, Durham VA Health Care System, Durham, NC 27710, USA. Electronic address:

Older adults are susceptible to serious illnesses, including atrial fibrillation, congestive heart failure, pneumonia, and pulmonary embolism. Atrial fibrillation is the most common arrhythmia in this age group and can cause complications such as thromboembolic events and stroke. Congestive heart failure is the most common cause of hospital admission and readmission in the older adult population. Read More

BMC Fam Pract 2021 Apr 15;22(1):75. Epub 2021 Apr 15.

Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.

Background: The primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years. The secondary objective was to evaluate the value of the practice fee as an instrument of allocation in patients with epistaxis.

Methods: Anonymized statutory health insurance data (AOK Lower Saxony) of patients with a diagnosis of epistaxis treated between 2007 and 2016 were examined. Read More

J Arrhythm 2021 Apr 23;37(2):448-449. Epub 2020 Nov 23.

Division of Cardiology Internal Medicine Ⅲ Hamamatsu University School of Medicine Hamamatsu Japan.

We report a case with a thrombus-like image on pulmonary valve detected by intracardiac echocardiography before transseptal puncture for atrial fibrillation (AF) ablation. The multimodality assessment provided diagnosis of the imaging artifact and exclusion from the harmful mass. This finding could be useful for a safety management of AF ablation and avoidance of an unnecessary interruption of the procedure. Read More

BMJ 2021 04 12;373:n379. Epub 2021 Apr 12.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. Read More

Ir J Med Sci 2021 Apr 12. Epub 2021 Apr 12.

Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel.

Aims: Management of patients with a single CHADS-VASc score risk factor is controversial. We attempt to identify the "truly low risk" AF patients who will not benefit from oral anticoagulation (OAC) treatment.

Methods: Retrospective cohort analysis, all incident non-valvular AF (NVAF) cases between 2004 and 2015, and age 21 and older, with up to one thromboembolic risk factor besides sex (CHADS-VASc score of up to 1 for men and up to 2 for women). Read More

Europace 2021 Apr;23(Supplement_2):ii46-ii51

Department of Cardiology, Martini Hospital, Van Swietenplein 1, 9728 NT Groningen, The Netherlands.

Current atrial fibrillation (AF) guidelines recommend screening for AF in individuals above 65 years or with other characteristics suggestive of increased stroke risk. Several mobile health (mHealth) approaches are available to identify AF. Although most wearables or ECG machines include algorithms to detect AF, an ECG confirmation of AF is necessary to establish a suspected diagnosis of AF. Read More

Ann Palliat Med 2021 Apr 1;10(4):4299-4307. Epub 2021 Apr 1.

Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.

Background: Several scores were available for predicting atrial fibrillation (AF) recurrence post radiofrequency ablation. However, the role of different scores predicting AF recurrence after ablation in patients with concurrent AF and pulmonary diseases (PDs) remained obscure. Herein, we aimed to investigate their predicting values and differences in patients with concurrent AF and PDs. Read More

Cureus 2021 Mar 3;13(3):e13663. Epub 2021 Mar 3.

Neurology, Jinnah Medical College Hospital, Karachi, PAK.

Background and objectives Cerebral venous sinus thrombosis (CVST) is a relatively rare and underdiagnosed type of stroke. Rivaroxaban is licensed for venous thromboembolism in patients opting for elective knee and hip replacement surgeries, preventing pulmonary embolism and precluding stroke and systemic embolism in sufferers of non-valvular atrial fibrillation. Beneficial outcomes depicting the efficacious role of rivaroxaban in treating CVST are under study. Read More

Ann Vasc Surg 2021 Apr 3. Epub 2021 Apr 3.

Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.

Objectives: Acute mesenteric ischemia (AMI) is a life-threatening condition associated with dismal outcomes. This study sought to evaluate the evolution of presentation, treatment, and outcomes of AMI over the past two decades.

Methods: AMI patients presenting at a single institution were reviewed (1993-2016). Read More

Therap Adv Gastroenterol 2021 21;14:1756284821997352. Epub 2021 Mar 21.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Background: Gastrointestinal (GI) bleeding is the most common type of major bleeding associated with oral anticoagulant (OAC) treatment. Patients with major bleeding are at an increased risk of a stroke if an OAC is not reinitiated.

Methods: Non-valvular atrial fibrillation (NVAF) patients initiating OACs were identified from the () Medicare data and four US commercial claims databases. Read More