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Background: The EQ-5D is one of the most commonly used tools to establish health-related quality of life (QoL). EQ-5D data in atrial fibrillation (AF) patients in the Middle East are lacking. Objectives: This study aims to evaluate the reliability and validity of the Arabic version of the EQ-5D in AF inpatients in Syria. Methods: The study involved patients admitted to the emergency department of Tishreen's University Hospital in Latakia with AF as the primary diagnosis between the 1st of June 2021 and the 1st of June 2023. Arabic versions of the EQ-5D, EQ-VAS and SF36 questionnaires were administered to patients. Validation was done using convergent, discriminant, and known-groups validity, while reliability was conducted using EQ-5D retesting within 2–4 weeks. Results: 432 participants were included in the study with a mean ± standard deviation of 63 ± 15. Males represented 242 (56%) of the participants. All hypotheses relating EQ-5D responses to external variables were satisfied. All three validation hypotheses demonstrated that the EQ-5D had the convergent, discriminant and known group validity to assess QoL in this cohort. The intraclass correlation coefficient (ICC) for test-retest reliability ranged between 0.74 and 0.88, while Cohen's κ ranged between 0.72 and 0.86. Cronbach's α value for internal consistency was 0.73. Conclusion: The Arabic version of EQ-5D was valid and reliable in measuring QoL in AF inpatients in Syria. This validation opens the door for more widespread use of the EQ-5D in Arabic-speaking regions, facilitating better-informed healthcare decisions and improving patient care strategies in Syria and other Middle Eastern countries. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of morbidity and mortality across the world and a significant portion of ischemic strokes have a cardiac source. We report a case of a 55‐year‐old male who presented with an ischemic stroke and bilateral pulmonary emboli secondary to an intra‐cardiac thrombus straddling a patent foramen ovale, which was clearly seen using transesophageal echocardiography. We discuss the management dilemma associated with this clinical picture given the risk of hemorrhagic transformation in the acute phase of an ischemic stroke. Our case demonstrates the need for a multidisciplinary approach in an area of medicine that lacks clear guidelines. [ABSTRACT FROM AUTHOR]

Twiddler syndrome, and the variant Reel syndrome, are rare but important complications of pacemaker implantation. We describe a rare complication of conventional permanent pacemaker implantation of rhythmic arm twitching secondary to brachial plexus stimulation from a displaced pacing lead caused by Reel syndrome. Twiddler syndrome and its variants are rare but important complications of pacemaker insertion. Holistic planning of cardiac procedures in elderly patients should identify those at risk to allow for targeted education and post-procedural care. [ABSTRACT FROM AUTHOR]

We report the first leadless pacemaker (L-PM) providing atrioventricular synchronous pacing implanted into a heart transplant patient receiving chronic immunosuppressive therapy. The patient presented with syncope corresponding to sinus rhythm with high-grade atrioventricular block. Previously, L-PMs provided only single-chamber ventricular sensing and pacing. A Micra AV lL-PM provides atrioventricular synchronous pacing by tracking mechanical atrial contraction. L-PMs, which now support broader indications, should be considered in patients at greater risk of infection. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 64-year-old man implanted with cardiac resynchronization therapy defibrillator and presented with shock during physical activity. The patient was implanted with the device for the prevention of sudden cardiac death due to his medical conditions such as ischemic cardiomyopathy and refractory heart failure.

Introduction Pulmonary vein isolation is an effective strategy in patients with atrial fibrillation ( AF). The peri-procedural use of anticoagulation is routinely employed to reduce thromboembolic risk. Aims/Methods The aim of this study was to compare the use of Dabigatran to the other 2 strategies involving the use of Warfarin. Single centre observational study comparing 3 anticoagulation strategies: Group 1 consisted of patients maintained on Warfarin (5.15 ± 2.52 mg) with a therapeutic INR of 2-3. Group 2 comprised patients initially treated with Warfarin (6.98 ± 3.17 mg), which was discontinued 1 week prior to LA ablation, during which time patients were bridged with a therapeutic dose of Dalteparin. Group 3 included patients anticoagulated with Dabigatran (40 patients received 150 mg BID, 3 patients received 110 mg BID), which was discontinued 24-30 h prior to the procedure. Results A total of 207 patients were included in the study. There were no significant differences in age, sex, LA volume, CHADS2 score or proportion of patients with persistent AF. There were no significant differences in the number of patients with intra-cardiac thrombus found at TOE (Group 1: 2.3% vs. Group 2: 1.5% vs. Group 3: 0%; P = 0.37). Furthermore, there were no differences in the rate of groin hematoma (2.2% vs. 1.5% vs. 2.3%; P = 0.8) or the development of pericardial effusion (5.4% vs. 8.8% vs. 2.3%; P = 0.54). No thromboembolic events were seen. Conclusion Peri-procedural use of Dabigatran during AF ablation procedures is safe, with no significant difference when compared to conventional anticoagulation with either Warfarin bridged with Dalteparin or uninterrupted Warfarin. [ABSTRACT FROM AUTHOR]

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OBJECTIVE--Emerging data implicate activation of the complement cascade in the pathogenesis of type 2 diabetes. The objective of the current study was to evaluate the relationships between components of the complement system, metabolic risk factors, and family history of type 2 diabetes in healthy South Asians. RESEARCH DESIGN AND METHODS--We recruited 119 healthy, first-degree relatives of South Asian subjects with type 2 diabetes (SARs) and 119 age- and sex-matched, healthy South Asian control subjects (SACs). Fasting blood samples were taken for measurement of complement factors and standard metabolic risk factors. RESULTS--SARs were characterized by significantly higher properdin (mean concentration 12.6 [95% CI 12.2-13.1] mg/L vs. SACs 10.1 [9.7-10.5] mg/L, P , 0.0001), factor B (187.4 [180.1-195.0] mg/L vs. SACs 165.0 [158.0-172.2]mg/L, P<0.0001), and SC5b-9 (92.0 [86.1- 98.3] ng/mL vs. SACs 75.3 [71.9-78.9] ng/mL, P < 0.0001) and increased homeostasis model assessment of insulin resistance (2.86 [2.61-3.13] vs. SACs 2.31 [2.05-2.61], P = 0.007). C-reactive protein did not differ between SARs and SACs (P = 0.17). In subgroup analysis of 25 SARs and 25 SACs with normal oral glucose tolerance tests, properdin, factor B, and SC5b-9 remained significantly elevated in SARs. CONCLUSIONS--Increased properdin and complement activation are associated with a family history of type 2 diabetes in South Asians independent of insulin resistance, and predate the development of impaired fasting glucose and impaired glucose tolerance. Properdin and SC5b-9 may be novel biomarkers for future risk of type 2 diabetes in this high-risk population and warrant further investigation. [ABSTRACT FROM AUTHOR]