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Polymorphic ventricular tachycardia (PVT) is a group of life-threatening heart rhythm disorders. These arrhythmias share similar electrocardiographic characteristics but require different modes of therapy for effective treatment. It is important to note that the medications that are considered the first-line treatment for one type of PVT may not be appropriate for another type, and may worsen the condition. Therefore, it is crucial to accurately diagnose the type of PVT before initiating treatment to provide the most effective therapy for the patient. A 42-year-old man was admitted to the emergency department with dyspnea, Levine sign, and severe chest pain. His electrocardiogram showed ST elevation, and the QT interval was normal. The patient was sent to the cath lab based on the treatment protocols. According to the results of angiography, three coronary arteries were severely obstructed. His coronary arteries did not open during percutaneous coronary intervention; thus, the healthcare team decided on open heart surgery. He suffered from recurrent PVT following open heart surgery and did not respond to any of the drugs suitable for this type of tachycardia. Inderal prevented the recurrence of ventricular tachycardia (VT) in a patient with polymorphic VT without QT prolongation, contrary to the healthcare team’s expectations. Inderal was used as the last line of treatment because this patient’s arrhythmia was polymorphic VT without QT prolongation. Inderal is typically used for treating VT in patients with long QT syndromes and heart structural disorders. This case report aims to highlight the impact of Inderal on polymorphic tachycardia, specifically in cases where the QT interval is not elongated. In this particular case, the standard treatment approaches were ineffective in preventing reversibility, but Inderal proved to be successful. Therefore, we feel it is important to document and share this case.

IntroductionChronic depression and anxiety can be a risk factor for coronary aArtery bypass grafting (CABG) and is an emerging factor after coronary artery disease when the patient is admitted to the hospital and after surgery. We aimed to assess the effect of Escitalopram in treating mild to moderate depressive disorder and improving the quality of life in patients undergoing CABG.MethodsIn this randomized clinical trial, 50 patients undergoing CABG referred to Tehran Heart Hospital from January 2021 to May 2021 and were suffering from mild to moderate depression were randomly assigned to one of the two groups of Escitalopram or placebo. The level of depression was assessed based on Beck’s depression inventory and the quality-of-life status and its domains were assessed based on the SF-36 questionnaire in 2 groups. Measurements were obtained at baseline and at four and eight weeks after treatment. Chi-square, Fisher’s exact, paired, and Wilcoxon tests or ANOVA were used as appropriate.ResultsThere was no significant difference between the level of depression between the two study groups at baseline (P=0.312). There was no significant difference between the quality of life and its domains in the two study groups at baseline (P=0.607). However, the most important effect of Escitalopram was reducing depression scores in the intervention group at weeks 4 and 8 after treatment compared to the placebo group (P0.05).ConclusionEscitalopram was effective in treating mild to moderate depressive disorder and improving quality of life in patients undergoing CABG.Clinical trial registrationhttps://irct.behdasht.gov.ir/, identifier IRCT20140126016374N2.

Background: Although a wide spectrum of resistance exercise intensities was recommended in the guidelines, none of them investigated the acute effects of different intensities of the resistance exercise on cardiac autonomic function in patients with chronic heart failure. This study aimed to investigate the acute effects of the low and high intensities of the resistance exercise on heart rate variability in chronic heart failure. Methods: This randomized controlled trial was performed between October 2019 and December 2020. Fifty-seven patients with chronic heart failure (New York Heart Association class II and class III) underwent hemodynamic, functional capacity, and heart rate variability (time and frequency domains) assessments. They were randomly divided into R1, R2, and control groups. The intervention consisted of performing a short aerobic exercise including 15 minutes of walking at an intensity of 50% reserved heart rate for all 3 groups and additional resistance exercise with the intensity of 50% 1-repetition maximum and 75% 1-repetition maximum for R1 and R2 groups, respectively. Results: The standard deviation of normal to normal intervals and standard deviation of average NN intervals became significantly lower in R2 (P =.031), and both high-frequency power and low-frequency power were significantly higher in R1 (P =.039 and P =.004, respectively) after the intervention. No significant changes were observed in the control group. Between-group changes were not significant for hemodynamics and functional capacity after treatment. The between-group comparison demonstrated a significant increase in root mean square of successive differences of the NN intervals in R1 in comparison to the control (P =.035). Conclusions: These findings indicate that resistance exercise in 50% 1-repetition maximum in comparison to 75% 1-repetition maximum had more favorable effects on the heart rate variability in chronic heart failure.

Background: Patients with chronic heart failure (CHF) are characterized by debilitating muscle weakness, the inability to move, and resultant psychological disadvantages. The current study investigated the acute effects of resistanceexercise (RE) and their impact on psychological health and peak muscle contraction (PMC) in patients with CHF.Methods: This randomized controlled trial was performed between October 2019 and December 2020. Fifty-seven patients with CHF (NYHA Class II, III) underwent initial assessments of the 6-minute walking test (6MWT),psychological response to exercise, and PMC. They were randomly divided into three groups, namely R1, R2, and the control group. The intervention consisted of a short aerobic exercise comprising 15 minutes of walking at an intensity of 50%-reserved heart rate for all three groups and an additional RE with the intensity of 50%-1RM and 75%-1RM for groups R1 and R2, respectively.Results: No significant difference among the groups were observed in 6MWT,peak muscle contraction, and psychological response to exercise after the intervention (P≥0.05). PMC and psychological response to exercise improved significantly in all groups; however, only group R2 showed a significant increase in 6MWT after the intervention. Positive well-being (PWB) had a positive correlation with peak muscle contraction of the left knee extensors and dorsiflexors, and psychological dystress (PD) and FAT were negatively correlated to walking distance and PMC of the left knee extensors and dorsiflexors.Conclusions: Performing just one session of exercise had significant beneficial impacts on PMC and psychological response in patients with CHF, regardless of exercise type or RE intensity. However, walking distance (6MWT) increasedsignificantly in the R2 group (75% of 1-RM), indicating that performing higher resistance exercise is safe and leads to functional advantages in CHF patients.There was a positive relationship between PWB and 1RM and a negativerelationship between both psychological distress (PD) and fatigue and 1RM.

Background: Iran is one of the countries hit hard and early by the corona virus disease 2019 (COVID-19) outbreak. Interventions for congenital and structural heart disease came to a halt in the initial part the year 2020, however as the pandemic seemed no closer to an end there was a mandate for elective catheterization procedures to be slowly and cautiously resumed. Aims and Objectives: In the present report we discuss the challenges we faced and the experiences earned as a cardiovascular tertiary center in the field of adult congenital and structural interventions in the COVID era. Material and Methods: Adult congenital and structural interventions were resumed in May 2020 with implementing strict screening protocols regulated by our institutional COVID committee. Patients were closely monitored for developing COVID-19 symptoms in hospital and two weeks following discharge. Results: In the regular review performed by the COVID committee there was no increase in new cases of the disease related to the interventional procedures and related admission. Conclusion: As the fate of pandemic remains unforeseeable, structural and congenital interventions need to be resumed in a sustainable fashion and with an instituted system of patient protection. The workflow might slow down during disease peaks with a catch-up in more stable disease periods.

INTRODUCTION: Providing information exchange and collaboration between isolated information systems (ISs) is essential in the health-care environments. In this context, we aimed to develop a communication protocol to facilitate better interoperability among electrophysiology study (EPS)-related ISs in order to allow exchange unified reporting in EPS ablation. MATERIALS AND METHODS: This study was an applied-descriptive research that was conducted in 2019. To determine the information content of agreed cardiac EPS Minimum Data Set (MDS) in Iran, the medical record of patients undergoing EPS ablation procedure in the Tehran Heart Center (THC) hospital was reviewed by a checklist. Then, an information model based on Health Level Seven, Clinical Document Architecture (HL7 CDA) standard framework for structural interoperability has been developed. In this framework, using NPEX online browser and MindMaple software, a set of terminology mapping rules was used for consistent transfer of data between various ISs. RESULTS: The information content of each data field was introduced into the heading and body sections of HL7 CDA document using Systematized Nomenclature of Medicine – Clinical Terminology names and codes. Then, the ontology alignment was designed in the form of thesaurus mapping routes. CONCLUSION: The sensitive, complex, and multidimensional nature of cardiovascular conditions requires special attention to the interoperability of ISs. Designing customized communication protocols plays an important role in improving the interoperability, and they are compatible with the needs of future Iranian health information exchange.

BACKGROUND: At present, there is no established national minimum data set (MDS) for electrophysiology study (EPS) ablation, which has led to a lack of standardization and variable assessment criteria in this context. OBJECTIVE: The objective of this paper was to develop a MDS of EPS ablation as means of establishing an information management system or clinical registry in this field. METHODS: In this cross-sectional and descriptive study, national and international cardiovascular scientific literature were studied to establish an initial set of data elements. In order to its validity, the population study composed of 15 cardiac electrophysiologists who asked to review the proposed data elements and score them in order of importance using a five-point Likert scale. The items scored as important or highly important by at least 60% of the experts (average score of 3 and higher) were included in the final list of MDS. RESULTS: An MDS of cardiac EPS ablation was created with nine data classes, including administrative data, past medical history, sign and symptoms, physical examinations, laboratory tests, presenting status of heart conduction system, catheter ablation, postprocedure complications, and discharge outcomes. For each category, required variables data and possible respondents were determined. CONCLUSIONS: Consensus was reached on a set of core data elements to standardize data collection for cardiac EPS ablation in order to achieve quality improvement and effectiveness indicators for the management of care process and health outcomes.