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Recent experimental evidence suggests combined treatment with midazolam and allopregnanolone is more effective than midazolam alone in terminating seizures triggered by acute organophosphate (OP) intoxication. However, there are concerns that combined midazolam and allopregnanolone increases risk of adverse cardiovascular events. To address this, we used telemetry devices to record cardiovascular responses in adult male Sprague-Dawley rats acutely intoxicated with diisopropylfluorophosphate (DFP). Animals were administered DFP (4 mg/kg, sc), followed immediately by atropine (2 mg/kg, i.m.) and 2-PAM (25 mg/kg, i.m.). At 40 min post-exposure, a subset of animals received midazolam (0.65 mg/kg, im); at 50 min, these rats received a second dose of midazolam or allopregnanolone (12 mg/kg, im). DFP significantly increased blood pressure by ~ 80 mmHg and pulse pressure by ~ 34 mmHg that peaked within 12 min. DFP also increased core temperature by ~ 3.5 °C and heart rate by ~ 250 bpm that peaked at ~ 2 h. Heart rate variability (HRV), an index of autonomic function, was reduced by ~ 80%. All acute (within 15 min of exposure) and two-thirds of delayed (hours after exposure) mortalities were associated with non-ventricular cardiac events within 10 min of cardiovascular collapse, suggesting that non-ventricular events should be closely monitored in OP-poisoned patients. Compared to rats that survived DFP intoxication without treatment, midazolam significantly improved recovery of cardiovascular parameters and HRV, an effect enhanced by allopregnanolone. These data demonstrate that midazolam improved recovery of cardiovascular and autonomic function and that the combination of midazolam and allopregnanolone may be a better therapeutic strategy than midazolam alone.

Recurrent benign gingival lesions occurring in the anterior dentition are clinical dilemmas. While complete removal of such lesions is required to prevent recurrence, this can result in a poor esthetic outcome. Relative to this conundrum, this report discusses the diagnosis, psychologic management, and clinical treatment of two patients with recurring lesions on the facial gingiva of the mandibular and maxillary incisors, respectively. Patient A, a 55-year-old woman, presented with a recurrent peripheral ossifying fibroma (POF); Patient B, a 76-year-old man, presented with a recurrent pyogenic granuloma (PG). Both patients underwent multiple procedures and were ultimately treated without lesion recurrence. The efficacious surgical treatment of recurrent gingival lesions like POF and PG requires an aggressive approach involving lesion removal of the lesion as well as a 1.0- to 2.0-mm margin of normal tissue, underlying alveolar bone, and associated periodontal ligament (PDL). The rationale for this approach stresses the potential periodontal and esthetic ramifications that were considered. In summary, when recurrent benign gingival lesions are localized to the anterior part of the mouth, the approach to their surgical removal should be modified to minimize the extent of gingival recession and other potential esthetic issues. [ABSTRACT FROM AUTHOR]

LncRNA-based control affects cardiac pathophysiologies like myocardial infarction, coronary artery disease, hypertrophy, and myotonic muscular dystrophy. This study used a gene-break transposon (GBT) to screen zebrafish (Danio rerio) for insertional mutagenesis. We identified three insertional mutants where the GBT captured a cardiac gene. One of the adult viable GBT mutants had bradycardia (heart arrhythmia) and enlarged cardiac chambers or hypertrophy; we named it bigheart. Bigheart mutant insertion maps to grin2bb or N-methyl D-aspartate receptor (NMDAR2B) gene intron 2 in reverse orientation. Rapid amplification of adjacent cDNA ends analysis suggested a new insertion site transcript in the intron 2 of grin2bb. Analysis of the RNA sequencing of wild-type zebrafish heart chambers revealed a possible new transcript at the insertion site. As this putative lncRNA transcript satisfies the canonical signatures, we called this transcript grin2bb associated RNA transcript (grin2bbART). Using in situ hybridization, we confirmed localized grin2bbART expression in the heart, central nervous system, and muscles in the developing embryos and wild-type adult zebrafish atrium and bulbus arteriosus. The bigheart mutant had reduced Grin2bbART expression. We showed that bigheart gene trap insertion excision reversed cardiac-specific arrhythmia and atrial hypertrophy and restored grin2bbART expression. Morpholino-mediated antisense downregulation of grin2bbART in wild-type zebrafish embryos mimicked bigheart mutants; this suggests grin2bbART is linked to bigheart. Cardiovascular tissues use Grin2bb as a calcium-permeable ion channel. Calcium imaging experiments performed on bigheart mutants indicated calcium mishandling in the heart. The bigheart cardiac transcriptome showed differential expression of calcium homeostasis, cardiac remodeling, and contraction genes. Western blot analysis highlighted Camk2d1 and Hdac1 overexpression. We propose that altered calcium activity due to disruption of grin2bbART, a putative lncRNA in bigheart, altered the Camk2d-Hdac pathway, causing heart arrhythmia and hypertrophy in zebrafish.

Background: An idiopathic outflow tract premature ventricular complex (OT-PVC) is a common arrhythmia, and the accuracy of site of origin prediction using the 12-lead electrocardiogram (ECG) algorithm is not high. There are no studies about a systematic strategy that can provide practical help to electrophysiologists in OT-PVC mapping and ablation. This study aims to evaluate the efficacy and safety of the proposed ablation protocol and establish an optimal catheter ablation strategy by simultaneously investigating and synthesizing various indicators observed during the mapping procedure. Methods and design: This study (ABOUT-PVC) was designed as a prospective multicenter study to enroll 210 patients from 11 tertiary university hospitals over an estimated 27 months. Patients with idiopathic OT-PVC requiring catheter ablation will receive the procedure through a proposed ablation strategy and will be followed up for at least 12 months. The primary outcome is the acute procedural success rate. The secondary outcomes are clinical success rate, procedure time, complication rate, symptom relief, and changes in echocardiographic parameters. Conclusions: The ABOUT-PVC study was designed to investigate the efficacy and safety of the proposed ablation strategy and establish an optimal catheter ablation strategy. We expect this study to overcome the limitations of the ECG prediction algorithms and provide a practical guide to electrophysiologists, increasing the procedure's success rate and reducing complications and procedure time. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation has an estimated prevalence of 1.5–2%, making it the most common cardiac arrhythmia. The processes that cause and sustain the disease are still not completely understood. An association between atrial fibrillation and systemic, as well as local, inflammatory processes has been reported. However, the exact mechanisms underlying this association have not been established. While it is understood that inflammatory macrophages can influence cardiac electrophysiology, a direct, causative relationship to atrial fibrillation has not been described. This study investigated the pro-arrhythmic effects of activated M1 macrophages on human induced pluripotent stem cell (hiPSC)-derived atrial cardiomyocytes, to propose a mechanistic link between inflammation and atrial fibrillation. Methods: Two hiPSC lines from healthy individuals were differentiated to atrial cardiomyocytes and M1 macrophages and integrated in an isogenic, pacing-free, atrial fibrillation-like coculture model. Electrophysiology characteristics of cocultures were analysed for beat rate irregularity, electrogram amplitude and conduction velocity using multi electrode arrays. Cocultures were additionally treated using glucocorticoids to suppress M1 inflammation. Bulk RNA sequencing was performed on coculture-isolated atrial cardiomyocytes and compared to meta-analyses of atrial fibrillation patient transcriptomes. Results: Multi electrode array recordings revealed M1 to cause irregular beating and reduced electrogram amplitude. Conduction analysis further showed significantly lowered conduction homogeneity in M1 cocultures. Transcriptome sequencing revealed reduced expression of key cardiac genes such as SCN5A, KCNA5, ATP1A1, and GJA5 in the atrial cardiomyocytes. Meta-analysis of atrial fibrillation patient transcriptomes showed high correlation to the in vitro model. Treatment of the coculture with glucocorticoids showed reversal of phenotypes, including reduced beat irregularity, improved conduction, and reversed RNA expression profiles. Conclusions: This study establishes a causal relationship between M1 activation and the development of subsequent atrial arrhythmia, documented as irregularity in spontaneous electrical activation in atrial cardiomyocytes cocultured with activated macrophages. Further, beat rate irregularity could be alleviated using glucocorticoids. Overall, these results point at macrophage-mediated inflammation as a potential AF induction mechanism and offer new targets for therapeutic development. The findings strongly support the relevance of the proposed hiPSC-derived coculture model and present it as a first of its kind disease model. [ABSTRACT FROM AUTHOR]

Proarrhythmic cardiotoxicity remains a substantial barrier to drug development as well as a major global health challenge. In vitro human pluripotent stem cell-based new approach methodologies have been increasingly proposed and employed as alternatives to existing in vitro and in vivo models that do not accurately recapitulate human cardiac electrophysiology or cardiotoxicity risk. In this study, we expanded the capacity of our previously established 3D human cardiac microtissue model to perform quantitative risk assessment by combining it with a physiologically based pharmacokinetic model, allowing a direct comparison of potentially harmful concentrations predicted in vitro to in vivo therapeutic levels. This approach enabled the measurement of concentration responses and margins of exposure for 2 physiologically relevant metrics of proarrhythmic risk (i.e. action potential duration and triangulation assessed by optical mapping) across concentrations spanning 3 orders of magnitude. The combination of both metrics enabled accurate proarrhythmic risk assessment of 4 compounds with a range of known proarrhythmic risk profiles (i.e. quinidine, cisapride, ranolazine, and verapamil) and demonstrated close agreement with their known clinical effects. Action potential triangulation was found to be a more sensitive metric for predicting proarrhythmic risk associated with the primary mechanism of concern for pharmaceutical-induced fatal ventricular arrhythmias, delayed cardiac repolarization due to inhibition of the rapid delayed rectifier potassium channel, or hERG channel. This study advances human-induced pluripotent stem cell-based 3D cardiac tissue models as new approach methodologies that enable in vitro proarrhythmic risk assessment with high precision of quantitative metrics for understanding clinically relevant cardiotoxicity. [ABSTRACT FROM AUTHOR]

Cardiac arrhythmia treatment is a clinical challenge necessitating safer and more effective therapies. Recent studies have highlighted the role of the perinexus, an intercalated disc nanodomain enriched in voltage-gated sodium channels including both Na v 1.5 and β1 subunits, adjacent to gap junctions. These findings offer insights into action potential conduction in the heart. A 19-amino acid SCN1B (β1/β1B) mimetic peptide, βadp1, disrupts VGSC beta subunit-mediated adhesion in cardiac perinexii, inducing arrhythmogenic changes. We aimed to explore βadp1's mechanism and develop novel SCN1B mimetic peptides affecting β1-mediated adhesion. Using patch clamp assays in neonatal rat cardiomyocytes and electric cell substrate impedance sensing (ECIS) in β1-expressing cells, we observed βadp1 maintained inhibitory effects for up to 5 h. A shorter peptide (LQLEED) based on the carboxyl-terminus of βadp1 mimicked this inhibitory effect, while dimeric peptides containing repeated LQLEED sequences paradoxically promoted intercellular adhesion over longer time courses. Moreover, we found a link between these peptides and β1-regulated intramembrane proteolysis (RIP) - a signaling pathway effecting gene transcription including that of VGSC subunits. βadp1 increased RIP continuously over 48 h, while dimeric agonists acutely boosted RIP for up to 6 h. In the presence of DAPT, an RIP inhibitor, βadp1's effects on ECIS-measured intercellular adhesion was reduced, suggesting a relationship between RIP and the peptide's inhibitory action. In conclusion, novel SCN1B (β1/β1B) mimetic peptides are reported with the potential to modulate intercellular VGSC β1-mediated adhesion, potentially through β1 RIP. These findings suggest a path towards the development of anti-arrhythmic drugs targeting the perinexus. [Display omitted] • Voltage-gated sodium channel β1 subunit offers novel anti-arrhythmic target. • β1 mimetic peptides increase regulated intramembrane proteolysis (RIP) of β1. • β1 mimetic peptide monomers decrease β1-mediated adhesion. • β1 mimetic peptide dimers stabilize or increase β1-mediated adhesion. [ABSTRACT FROM AUTHOR]

Although short-term rental platforms (e.g. Airbnb) are often not considered labour platforms, their suppliers must contend with demands on labour structured by the platforms. Using Lefebvre's rhythmanalysis, this article examines the spatio-temporal dynamics of cleaning labour for STR platforms through the experiences of student-migrant-workers in Montreal between 2017 and 2020. I argue that yield-focused STR operators (i.e. owner-operators and managers) encounter spatio-temporal friction (or arrhythmia) in their efforts to outsource STR cleaning labour, but some labour intermediaries have responded with strategies to bring this conflict into harmony (eurhythmia) by incorporating the lives and labour of student-migrant-workers. At once limited in their employment options and not exclusively dependent on this work, student-migrant-workers illustrate characteristics that these intermediaries require of the workers they assemble and the flexible labour force upon which STR platforms depend. Rather than replacing labour intermediaries, online platforms have created new spatio-temporal dynamics for labour and new opportunities for those who profit from assembling the labour forces that address them. [ABSTRACT FROM AUTHOR]

This article discusses a case of neonatal flecainide toxicity resulting from a dosing error. It explores the narrow therapeutic index of flecainide and the potential for toxicity in pediatric patients. The article highlights previous cases of dosing errors and their adverse effects. It also discusses the use of activated charcoal and sodium bicarbonate as treatments for flecainide toxicity, as well as other interventions that have shown promise. The document concludes by suggesting measures to prevent dosing errors in the pediatric population. [Extracted from the article]

Oxidative phosphorylation is regulated by mitochondrial calcium (Ca2+) in health and disease. In physiological states, Ca2+ enters via the mitochondrial Ca2+ uniporter and rapidly enhances NADH and ATP production. However, maintaining Ca2+ homeostasis is critical: insufficient Ca2+ impairs stress adaptation, and Ca2+ overload can trigger cell death. In this review, we delve into recent insights further defining the relationship between mitochondrial Ca2+ dynamics and oxidative phosphorylation. Our focus is on how such regulation affects cardiac function in health and disease, including heart failure, ischemia-reperfusion, arrhythmias, catecholaminergic polymorphic ventricular tachycardia, mitochondrial cardiomyopathies, Barth syndrome, and Friedreich's ataxia. Several themes emerge from recent data. First, mitochondrial Ca2+ regulation is critical for fuel substrate selection, metabolite import, and matching of ATP supply to demand. Second, mitochondrial Ca2+ regulates both the production and response to reactive oxygen species (ROS), and the balance between its pro- and antioxidant effects is key to how it contributes to physiological and pathological states. Third, Ca2+ exerts localized effects on the electron transport chain (ETC), not through traditional allosteric mechanisms but rather indirectly. These effects hinge on specific transporters, such as the uniporter or the Na+/Ca2+ exchanger, and may not be noticeable acutely, contributing differently to phenotypes depending on whether Ca2+ transporters are acutely or chronically modified. Perturbations in these novel relationships during disease states may either serve as compensatory mechanisms or exacerbate impairments in oxidative phosphorylation. Consequently, targeting mitochondrial Ca2+ holds promise as a therapeutic strategy for a variety of cardiac diseases characterized by contractile failure or arrhythmias. [ABSTRACT FROM AUTHOR]

This paper reviews arrhythmia classification studies using electrocardiogram (ECG) signals. Research on automatically diagnosing arrhythmia in daily life has been actively underway for early detection and treatment of heart disease. Development of automatic arrhythmia classification using ECG signal began based on handcrafted morphological feature extraction and machine learning-based classification methods. As deep neural networks (DNN) show excellent performance in the signal processing field, studies using various types of DNN are also being conducted in ECG classification. However, these DNN-based studies have extremely high computational complexity, making it challenging to perform real-time classification, and are unsuitable for low-power environments such as wearable devices due to high power consumption. Currently, research based on spiking neural network (SNN), which mimics the low-power operation of the human nervous system, is attracting attention as a method that can dramatically reduce complexity and power consumption. The classification accuracy of the SNN-based ECG classification studies is close to that of the DNN-based studies. When combined with neuromorphic hardware, it shows ultra-low-power performance, suggesting the possibility of use in lightweight devices. In this paper, the SNN-based ECG classification studies for low-power environments are mainly reviewed, and prior to this, conventional and DNN-based ECG classification studies are also reviewed. We hope that this review will be helpful to researchers and engineers interested in the field of ECG classification. [ABSTRACT FROM AUTHOR]

In general, arrhythmias, also called cardiac arrhythmia, heart arrhythmia, or dysrhythmias, are abnormal heartbeats which include too fast or too slow. The Cardiovascular Disease (CVD) is a significant cause of death, and the death rate is increasing every year. The Electrocardiogram (ECG) majorly contributes to the CVD diagnosis, providing information about the heartbeat. An automatic detection and classification of arrhythmia performs a significant role in managing and curing cardiovascular diseases. Deep Learning (DL)-based algorithms have emerged as effective solutions in medical applications, particularly in cardiac arrhythmia diagnosis. In this research, a DL-based multi-modal approach is proposed for the classification of cardiac arrhythmia. The MIT-BIH dataset is utilized to evaluate the performance of the proposed method. The proposed method considers physiological signals along with the MIT-BIH dataset to improve accuracy. The Discrete Wavelet Transform (DWT) is used for pre-processing the MIT-BIH dataset. The DL methods of Recurrent Neural Network (RNN) and Long Short-Term Memory (LSTM) are utilized for classifying cardiac arrhythmia. The proposed method is evaluated using various performance metrics such as Accuracy, Specificity, Sensitivity, F1-score, and Cohens kappa. [ABSTRACT FROM AUTHOR]

Background: Recently, treatment of equine atrial tachycardia by three‐dimensional electro‐anatomical mapping (3D EAM) and radiofrequency catheter ablation (RFCA) has been described. Myocardial sleeves in the caudal vena cava and pulmonary veins are a potential trigger for initiation and perpetuation of atrial tachycardia and atrial fibrillation in the horse. Isolation of these myocardial sleeves by RFCA may be an effective treatment for these arrhythmias. Objectives: To describe the feasibility of 3D EAM and RFCA to isolate caudal vena cava and pulmonary veins in adult horses using 3D mapping and a contact force (CF)‐guided ablation system. Study design: In vivo experiments. Methods: 3D EAM and RFCA was performed in five horses without cardiovascular disease under general anaesthesia, using the CF‐guided system CARTO®3. Point‐by‐point RFCA aimed for isolation of caudal vena cava and pulmonary veins. Radiofrequency energy was delivered in power‐controlled mode with a target power of 45 W, CF between 10 and 15 g and 30 mL/min irrigation rate, until an ablation‐index of 450–500 was reached. Results: In the right atrium, myocardial sleeves of the caudal vena cava were isolated (n = 5). In the left atrium, isolation of ostium II (n = 3), ostium III (n = 1) and ostium I, II and III en bloc (n = 1) was performed. Successful isolation was confirmed by entrance and exit block. Main limitations: Horses were euthanised at the end of the procedure, so long term effects such as potential reconnection of isolated veins could not be studied. Conclusions: This is the first description of 3D EAM and RFCA with CARTO®3 in horses, thereby showing the technical feasibility and successful caudal vena cava and pulmonary vein isolation. CF measurement allowed monitoring of catheter‐tissue contact, resulting in efficient acute lesion creation as confirmed by entrance and exit block. This is a promising treatment for cardiac arrhythmias in horses. [ABSTRACT FROM AUTHOR]

Cardiac arrhythmia identification and categorization are crucial for prompt treatment and better patient outcomes. Arrhythmia identification is the main focus of this study's temporal attention network (TAN)-based multiclass categorization of varied-length electrocardiogram (ECG) data. The suggested TAN is designed to handle variable-duration ECG signals, making it ideal for real-time monitoring. The TAN uses a dynamic snippet extraction approach to choose meaningful ECG segments to ensure the model captures essential properties despite the constraints of processing such heterogeneous data. Training and assessment use a large dataset of atrial fibrillation, ventricular, and supraventricular arrhythmias. The TAN outperforms current approaches in multiclass early arrhythmia classification and is very accurate. Concatenating EfficientNet with CNN layer helped overcome different data and variable-length signals. High accuracy: 98% of normal, 97.1% of atrial fibrillation (AF), 98% of other, and 98% of noisy using the proposed CEEC model. Early arrhythmia diagnosis has improved due to the TAN's ability to effectively identify varied-length ECG data and give interpretability. It enables quicker interventions, personalised treatment plans, and improved arrhythmia control, which can greatly benefit patient care. [ABSTRACT FROM AUTHOR]

An arrhythmia is just a disease associated with irregular heart rhythm. Any kind of arrhythmia can be determined with an ECG test. However, this requires long and excellent-quality of ECG samples. This makes an affordable, reliable, and automated system for recognizing and diagnosing arrhythmias. To meet the aforementioned criteria, a new technique with the aid of an attention-aided deep learning approach is proposed to classify arrhythmia in this paper. "Higher-order statistical (HOS)" features are extracted from the original EEG signal and the deep features are obtained from the analyzed QRS complex signals and RR interval by means of a "One-Dimensional Convolution Neural Network (1DCNN)". The Risk Rate Enhanced Lemurs Optimization Algorithm (RRE-LOA) is utilized to modify the weight, and the extracted features are selected optimally before carrying out the feature selection followed by feature concatenation with weight fusion in order to generate the Weighted Fused Features (WFF). A range of indicators is used to compare the performance of the executed classification model with the traditional models. The results demonstrate that the proposed methodology for classifying arrhythmias offers an enhanced performance while classifying the arrhythmia thus aiding in faster treatment of the arrhythmia disease. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a rarely reported arrhythmia in otherwise healthy newborn foals, with a single case of cardioversion using procainamide administration described in the literature. Two neonatal Thoroughbred colts were presented to an equine hospital because of an irregularly irregular tachyarrhythmia and poor latching when trying to nurse. History, physical examination, and initial diagnostic testing including ECG and echocardiography confirmed AF without structural heart disease. The 1st foal converted into normal sinus rhythm after treatment with IV metoprolol and quinidine. The 2nd foal converted to normal sinus rhythm after a single IV dose of metoprolol, intended for rate control. Demeanor and nursing behavior improved markedly after conversion. The 2 foals had normal heart rates and sinus rhythm that persisted for 6 weeks until euthanasia in the 1st foal and for 2 years in the 2nd foal. Rate control and cardioversion should be considered as a treatment for persistent lone AF in neonatal foals. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusions We aimed to investigate the long‐term impact of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) on thyroid function, cardiovascular health, renal outcomes and adverse events in individuals with obesity and without type 2 diabetes (T2D).In this observational cohort study, we used propensity score matching to construct comparable cohorts of individuals with obesity and without T2D who were new to GLP‐1 RA treatment and those who did not receive glucose‐lowering medications. In total, 3,729,925 individuals with obesity were selected from the TriNetX Global Network, with an index event between 1 January 2016 and 31 March 2024. The primary outcomes were safety, cardiovascular, thyroid and clinical biochemical profile outcomes occurring within 5 years following the index event.After propensity score matching, the study included 12,123 individuals in each group. GLP‐1 RA treatment was associated with a significantly lower risk of all‐cause mortality (hazard ratio 0.23; 95% confidence interval 0.15–0.34) and several cardiovascular complications, including ischaemic heart disease, heart failure, arrhythmias, hypertension, stroke and atrial fibrillation (all p < 0.05). GLP‐1 RAs were also associated with a lower risk of acute kidney injury and allergic reactions. These protective effects were consistent across various subgroups and regions.In this large observational study, GLP‐1 RAs showed long‐term protective effects on cardiovascular health, renal outcomes and adverse events in individuals with obesity and without T2D. Our findings suggest that GLP‐1 RAs may offer a comprehensive approach to managing obesity and its related comorbidities, potentially improving overall health and survival in this population. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion Chimeric antigen receptor T‐cell (CAR‐T) therapy has shown promise in treating hematologic malignancies, yet its potential cardiotoxic effects require thorough investigation.We aim to conduct a systematic review and meta‐analysis to examine the cardiotoxic effects of CAR‐T therapy in adults with hematologic malignancies.We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting cardiovascular outcomes, such as arrhythmias, heart failure, and reduced left ventricle ejection fraction (LVEF).Our analysis of 20 studies involving 4789 patients revealed a 19.68% incidence rate of cardiovascular events, with arrhythmias (7.70%), heart failure (5.73%), and reduced LVEF (3.86%) being the most prevalent. Troponin elevation was observed in 23.61% of patients, while NT‐Pro‐BNP elevation was observed in 9.4. Subgroup analysis showed higher risks in patients with pre‐existing conditions, such as atrial arrhythmia (OR 3.12; p < .001), hypertension (OR 1.85; p = .002), previous heart failure (OR 3.38; p = .003), and coronary artery disease (OR 2.80; p = .003).Vigilant cardiovascular monitoring is crucial for patients undergoing CAR‐T therapy to enhance safety and treatment efficacy.Novelty Statements. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the successful identification and treatment of severe hyperkalemia, cardiac arrhythmia, rhabdomyolysis, and acute kidney injury (AKI) in a domestic cat that underwent general anesthesia for abdominal exploratory surgery. The definitive underlying cause remains unknown; however, a reaction to propofol is suspected. Case summary: A 6-month-old intact male domestic short-hair cat underwent general anesthesia and developed severe intraoperative rhabdomyolysis, hyperkalemia, ventricular fibrillation, and AKI during surgery despite a documented mild hypokalemia and normal creatinine before inducing anesthesia. Propofol was administered as part of the anesthetic protocol. The patient was resuscitated successfully and responded well to advanced medical intervention. The hyperkalemia and AKI were resolved within less than 24 h from surgery and rhabdomyolysis was resolved at the time of recheck 5 days later. New or unique information provided: While previously suspected in dogs, to the authors' knowledge, propofol-related infusion syndrome (PRIS) has not been reported in domestic cats. Veterinary professionals should be aware that drug-induced intraoperative rhabdomyolysis and hyperkalemia can develop unexpectedly and should remain a differential for acute cardiac arrhythmias or cardiac arrest and AKI. [ABSTRACT FROM AUTHOR]

This article discusses several hot topics in the field of cardiovascular health. It includes a review of left atrial appendage closure (LAAC) as an alternative treatment for stroke prevention in patients with atrial fibrillation (AF). The article also examines the safety of home treatment for acute pulmonary embolism (PE) patients and the efficacy of pulmonary artery (PA)-guided therapy for chronic heart failure (HF) patients. Additionally, the article presents a novel tool for arrhythmic risk stratification in patients with desmoplakin gene variants and evaluates the risk of thromboembolic events after COVID-19 vaccination in patients with AF. The authors provide insights, data, and recommendations for each topic, highlighting the need for further research and individualized care. [Extracted from the article]

Background and Aims Pathogenic desmoplakin (DSP) gene variants are associated with the development of a distinct form of arrhythmogenic cardiomyopathy known as DSP cardiomyopathy. Patients harbouring these variants are at high risk for sustained ventricular arrhythmia (VA), but existing tools for individualized arrhythmic risk assessment have proven unreliable in this population. Methods Patients from the multi-national DSP-ERADOS (Desmoplakin SPecific Effort for a RAre Disease Outcome Study) Network patient registry who had pathogenic or likely pathogenic DSP variants and no sustained VA prior to enrolment were followed longitudinally for the development of first sustained VA event. Clinically guided, step-wise Cox regression analysis was used to develop a novel clinical tool predicting the development of incident VA. Model performance was assessed by c -statistic in both the model development cohort (n = 385) and in an external validation cohort (n = 86). Results In total, 471 DSP patients [mean age 37.8 years, 65.6% women, 38.6% probands, 26% with left ventricular ejection fraction (LVEF) < 50%] were followed for a median of 4.0 (interquartile range: 1.6–7.3) years; 71 experienced first sustained VA events {2.6% [95% confidence interval (CI): 2.0, 3.5] events/year}. Within the development cohort, five readily available clinical parameters were identified as independent predictors of VA and included in a novel DSP risk score: female sex [hazard ratio (HR) 1.9 (95% CI: 1.1–3.4)], history of non-sustained ventricular tachycardia [HR 1.7 (95% CI: 1.1–2.8)], natural logarithm of 24-h premature ventricular contraction burden [HR 1.3 (95% CI: 1.1–1.4)], LVEF < 50% [HR 1.5 (95% CI:.95–2.5)], and presence of moderate to severe right ventricular systolic dysfunction [HR 6.0 (95% CI: 2.9–12.5)]. The model demonstrated good risk discrimination within both the development [ c -statistic.782 (95% CI:.77–.80)] and external validation [ c -statistic.791 (95% CI:.75–.83)] cohorts. The negative predictive value for DSP patients in the external validation cohort deemed to be at low risk for VA (<5% at 5 years; n = 26) was 100%. Conclusions The DSP risk score is a novel model that leverages readily available clinical parameters to provide individualized VA risk assessment for DSP patients. This tool may help guide decision-making for primary prevention implantable cardioverter-defibrillator placement in this high-risk population and supports a gene-first risk stratification approach. [ABSTRACT FROM AUTHOR]

Background: A relatively common complication of COVID -19 infection is arrhythmia. There is limited information about myocardial deformation and heart rate variability (HRV) in symptomatic post COVID patients presented by ventricular arrhythmia. Aim of the study: Our goal was to assess 2D-ventricular strain and heart rate variability indices (evaluated by ambulatory ECG monitoring) in post-COVID-19 patients suffering from ventricular arrhythmia. Methods: The current observational case–control study performed on 60 patients one month after they had recovered from the COVID-19 infection. Thirty healthy volunteers served as the control group. Each participant had a full medical history review, blood tests, a 12-lead surface electrocardiogram (ECG), 24-h ambulatory ECG monitoring, and an echo-Doppler examination to evaluate the left ventricular (LV) dimensions, tissue Doppler velocities, and 2D-speckle tracking echocardiography (2D-STE) for both the LV and right ventricular (RV) strain. Results: Symptomatic post-COVID patients with monomorphic premature ventricular contractions (PVCs) showed a substantial impairment of LV/RV systolic and diastolic functions, LV/RV myocardial performance (MPI) with reduced indices of HRV. Patients with higher versus lower ventricular burden had poorer functional status, higher levels of inflammatory biomarkers and reduced parameters of HRV (New York Heart Association (NYHA) class: 2.1 ± 0.9 vs. 1.5 ± 0.6, p < 0.001, C-reactive protein (CRP): 13.3 ± 4.1 vs. 8.3 ± 5.9 mg/L, p < 0.0001, low frequency/high frequency (LF/HF): 3.6 ± 2.4 vs. 2.2 ± 1.2, p < 0.002, the root mean square of the difference between successive normal intervals (rMSSD): 21.8 ± 4.7 vs. 29.3 ± 14.9 ms, p < 0.039 and the standard deviation of the RR interval (SDNN): 69.8 ± 19.1 vs.108.8 ± 37.4 ms, p < 0.0001). The ventricular burden positively correlated with neutrophil/lymphocyte ratio (NLR) (r = 0.33, p < 0.001), CRP (r = 0.60, p < 0.0001), while it negatively correlated with LV-global longitudinal strain (GLS) (r = -0.38, p < 0.0001), and RV-GLS (r = -0.37, p < 0.0001). Conclusions: Patients with post-COVID symptoms presented by ventricular arrhythmia had poor functional status. Patients with post-COVID symptoms and ventricular arrhythmia had subclinical myocardial damage, evidenced by speckle tracking echocardiography while having apparently preserved LV systolic function. The burden of ventricular arrhythmia in post-COVID patients significantly correlated with increased inflammatory biomarkers and reduced biventricular strain. [ABSTRACT FROM AUTHOR]

Identifying and treating pediatric arrhythmias is essential for pediatric anesthesiologists. Pediatric patients can present with narrow or wide complex tachycardias, though the former is more common. Patients with inherited channelopathies or cardiomyopathies are at increased risk. Since most pediatric patients present for anesthesia without a baseline electrocardiogram, the first identification of an arrhythmia may occur under general anesthesia. Supraventricular tachycardia, the most common pediatric tachyarrhythmia, represents a broad category of predominately narrow complex tachycardias. Stimulating events including intubation, vascular guidewire manipulation, and surgical stimulation can trigger episodes. Valsalva maneuvers are unreliable as treatment, making adenosine or other intravenous antiarrhythmics the preferred acute therapy. Reentrant tachycardias are the most common supraventricular tachycardia in pediatric patients, including atrioventricular reciprocating tachycardia (due to a distinct accessory pathway) and atrioventricular nodal reentrant tachycardia (due to an accessory pathway within the atrioventricular node). Patients with ventricular preexcitation, often referred to as Wolff‐Parkinson‐White syndrome, have a wide QRS with short PR interval, indicating antegrade conduction through the accessory pathway. These patients are at risk for sudden death if atrial fibrillation degenerates into ventricular fibrillation over a high‐risk accessory pathway. Automatic tachycardias, such as atrial tachycardia and junctional ectopic tachycardia, are causes of supraventricular tachycardia in pediatric patients, the latter most typically noted after cardiac surgery. Patients with inherited arrhythmia syndromes, such as congenital long QT syndrome, are at risk of developing ventricular arrhythmias such as polymorphic ventricular tachycardia (Torsades de Pointes) which can be exacerbated by QT prolonging medications. Patients with catecholaminergic polymorphic ventricular tachycardia are at particular risk for developing bidirectional ventricular tachycardia or ventricular fibrillation during exogenous or endogenous catecholamine surges. Non‐selective beta blockers are first line for most forms of long QT syndrome as well as catecholaminergic polymorphic ventricular tachycardia. Anesthesiologists should review the impact of medications on the QT interval and transmural dispersion of repolarization, to limit increasing the risk of Torsades de Pointes in patients with long QT syndrome. This review explores the key anesthetic considerations for these arrhythmias. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most prevalent arrhythmia characterized by intermittent and asymptomatic episodes. However, traditional detection methods often fail to capture the sporadic and intricate nature of AF, resulting in an increased risk of false-positive diagnoses. To address these challenges, this study proposes an intelligent AF detection and diagnosis method that integrates Complementary Ensemble Empirical Mode Decomposition, Power-Normalized Cepstral Coefficients, Bi-directional Long Short-term Memory (CEPNCC-BiLSTM), and photoelectric volumetric pulse wave technology to enhance accuracy in detecting AF. Compared to other approaches, the proposed method demonstrates faster preprocessing efficiency and higher sensitivity in detecting AF while effectively filtering out false alarms from photoplethysmography (PPG) recordings of non-AF patients. Considering the limitations of conventional AF detection evaluation systems that lack a comprehensive assessment of efficiency and accuracy, this study proposes the ET-score evaluation system based on F-measurement, which incorporates both computational speed and accuracy to provide a holistic assessment of overall performance. Evaluated with the ET-score, the CEPNCC-BiLSTM method outperforms EEMD-based improved Power-Normalized Cepstral Coefficients and Bi-directional Long Short-term Memory (EPNCC-BiLSTM), Support Vector Machine (SVM), EPNCC-SVM, and CEPNCC-SVM methods. Notably, this approach achieves an outstanding accuracy rate of up to 99.2% while processing PPG recordings within 5 s, highlighting its potential for long-term AF monitoring. [ABSTRACT FROM AUTHOR]

Arrhythmias range from mild nuisances to potentially fatal conditions, detectable through electrocardiograms (ECGs). With advancements in wearable technology, ECGs can now be monitored on-the-go, although these devices often capture noisy data, complicating accurate arrhythmia detection. This study aims to create a new deep learning model that utilizes generative adversarial networks (GANs) for effective noise removal and ResNet for precise arrhythmia classification from wearable ECG data. We developed a deep learning model that cleans ECG measurements from wearable devices and detects arrhythmias using refined data. We pretrained our model using the MIT-BIH Arrhythmia and Noise databases. Least squares GANs were used for noise reduction, maintaining the integrity of the original ECG signal, while a residual network classified the type of arrhythmia. After initial training, we applied transfer learning with actual ECG data. Our noise removal model significantly enhanced data clarity, achieving over 30 dB in a signal-to-noise ratio. The arrhythmia detection model was highly accurate, with an F1-score of 99.10% for noise-free data. The developed model is capable of real-time, accurate arrhythmia detection using wearable ECG devices, allowing for immediate patient notification and facilitating timely medical response. [ABSTRACT FROM AUTHOR]

Over the past decade, the use of biometrics in security systems and other applications has grown in popularity. ECG signals in particular are attracting increased attention due to their characteristics, which are required for a trustworthy identification system. The majority of ECG-based person identification systems are evaluated without considering the health-state of the individuals. Few person identification systems consider person-by-person health-state annotation. This paper proposes a person identification system considering the health-state annotated ECG signals where each person's beats overlap among variant arrhythmia classes. This overlapping between the normal class and other arrhythmia classes grants the ability to isolate normal beats in the train set from the Arrhythmic beats in the test set. Therefore, this paper investigates the effect of arrhythmic heartbeats on biometric recognition. An effective lightweight CNN based on depth-wise separable convolution (DWSC) is proposed to enhance the performance of person identification for several common arrhythmia types using the MITBIH dataset. The proposed methodology has been tested on nine arrhythmia types and presents how different types of arrhythmia affect ECG-based biometric systems differently. The experimental results show excellent recognition performance (99.28%) on normal heartbeats and (93.81%) on arrhythmic heartbeats, outperforming other models in terms of mean accuracy. [ABSTRACT FROM AUTHOR]