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Arrhythmia is the main cause of pregnancy-related hospitalizations. Potential risk of arrhythmias during pregnancy is associated with hypercoagulation and increased risk of thromboembolism. The aim. To increase patients’ safety and to improve maternal and perinatal outcomes by choosing the optimal medical strategy. Methods. We present the experience of multidisciplinary care for 54 pregnant and parturient women (32 with tachy-, 20 with bradyarrhythmia and 2 with ventricular asynchrony) who were admitted to the cardiac surgery facility from December 2013 to February 2022. Pacemakers were implanted in 15 cases of complete atrioventricular block radiofrequency ablation was performed in 12 cases. Results. There were no near misses and maternal losses in our group of patients. Two programmed perinatal losses were provided in patients with rhythm disorders and complex congenital heart defects. Type and place of delivery were chosen by the multidisciplinary team. There were nine childbirths at a specialized cardiac surgery clinic. There were no perinatal losses among patients who underwent rhythm interventions. In our group of patients, electrical cardioversion was performed in three cases, the pregnancies ended successfully with the birth of healthy newborns. Conclusions. Arrhythmias in all trimesters of pregnancy and the postpartum period are a common reason for seeking medical attention and hospitalization during pregnancy.Most of the arrhythmias are hemodynamically insignificant and don’t require hospitalization. Maternal risk stratification of major cardiac events during pregnancy, childbirth and the postpartum period is the cornerstone for choosing a strategy of medical care for pregnant women with arrhythmias. Patients with hemodynamic manifestations of tachy- and bradyarrhythmias, as well as patients with life-threatening types of rhythm disturbances are in the focus of attention of pregnancy heart team. Preconceptional management of patients with life threating arrhythmias is the best type of care in these patients. Pregnancy and delivery in high-risk class patients should be managed in an experienced center with on-site interventional electrophysiology techniques. Rhythm interventions have extremely limited indications and can be conducted when less invasive treatment strategy is unsuccessful.

Chagas Disease (CD) is highly prevalent among the indigenous populations in the Sierra Nevada de Santa Marta, Colombia. Villages examined show prevalence rates ranging from 43.6% up to 67.4%. In the present study, associated medical conditions were assessed with a particular focus on ECG alterations. CD diagnosis was based on a rapid test, two different ELISAs, and a specific and highly sensitive Chagas real-time PCR. In both CD positive and CD negative patients, relations of the status and medical (physical examination-based, questionnaire-based) and/or electrocardiogram-based findings were investigated. As expected, CD-associated symptoms and complaints were predominantly found in CD-positive patients. Interestingly, ECG-findings were found to show the potential of leading to early CD diagnosis because ECG alterations were already seen in early stagechanges of the disease. In conclusion, although the observed ECG changes are unspecific, they should be considered as an indicator for a CD screening and, in case of positive results, an associated early treatment of the disease.

Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder characterised by restrictive patterns of behaviour and alterations in social interaction and communication. Up to 80% of children with ASD exhibit sleep-wake cycle disturbances, emphasising the pressing need for novel approaches in the treatment of ASD-associated comorbidities. While sleep disturbances have been identified in ASD individuals, little has been done to assess the contribution of the circadian system to these findings. The objective of this study is to characterise circadian behaviour and clock-gene expression in a valproic acid (VPA)-induced animal model of autism to highlight perturbations potentially contributing to these disturbances. Male and female VPA-exposed offspring underwent circadian challenges, including baseline light-dark cycles, constant dark/light and light pulse protocols. Baseline analysis showed that VPA-exposed males, but not females, had a greater distribution of wheel-running behaviour across light-dark phases and a later activity offset (p < 0.0001), while controls showed greater activity confinement to the dark phase (p = 0.0256). Constant light analysis indicated an attenuated masking response and an increase in the number of days to reach arrhythmicity (p < 0.0001). A 1-h light pulse (150 lux) at CT 15 after 6 days of constant dark showed that both sexes exposed to VPA exhibited a lesser phase-shift when compared to controls (p = 0.0043). Immunohistochemical and western-blot assays reveal no alterations in retinal organisation or function. However, immunohistochemical assay of the SCN revealed altered expression of BMAL1 expression in VPA-exposed males (p = 0.0016), and in females (p = 0.0053). These findings suggest alterations within the core clockwork of the SCN and reduced photic-entrainment capacity, independent of retinal dysfunction. The results of this study shed light on the nature of circadian dysregulation in VPA-exposed animals and highlights the urgent need for novel perspectives in the treatment of ASD-associated comorbidities. [ABSTRACT FROM AUTHOR]

Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder characterised by restrictive patterns of behaviour and alterations in social interaction and communication. Up to 80% of children with ASD exhibit sleep-wake cycle disturbances, emphasising the pressing need for novel approaches in the treatment of ASD-associated comorbidities. While sleep disturbances have been identified in ASD individuals, little has been done to assess the contribution of the circadian system to these findings. The objective of this study is to characterise circadian behaviour and clock-gene expression in a valproic acid (VPA)-induced animal model of autism to highlight perturbations potentially contributing to these disturbances. Male and female VPA-exposed offspring underwent circadian challenges, including baseline light-dark cycles, constant dark/light and light pulse protocols. Baseline analysis showed that VPA-exposed males, but not females, had a greater distribution of wheel-running behaviour across light-dark phases and a later activity offset (p < 0.0001), while controls showed greater activity confinement to the dark phase (p = 0.0256). Constant light analysis indicated an attenuated masking response and an increase in the number of days to reach arrhythmicity (p < 0.0001). A 1-h light pulse (150 lux) at CT 15 after 6 days of constant dark showed that both sexes exposed to VPA exhibited a lesser phase-shift when compared to controls (p = 0.0043). Immunohistochemical and western-blot assays reveal no alterations in retinal organisation or function. However, immunohistochemical assay of the SCN revealed altered expression of BMAL1 expression in VPA-exposed males (p = 0.0016), and in females (p = 0.0053). These findings suggest alterations within the core clockwork of the SCN and reduced photic-entrainment capacity, independent of retinal dysfunction. The results of this study shed light on the nature of circadian dysregulation in VPA-exposed animals and highlights the urgent need for novel perspectives in the treatment of ASD-associated comorbidities.

Aim. To identify the relationship between rhythm disturbances, including ventricular tachycardia (VT), and the small intestinal bowel bacterial overgrowth syndrome in chronic heart failure (CHF) with left ventricular systolic dysfunction. Materials and methods. The study included 60 patients with CHF with systolic dysfunction of the left ventricle (left ventricular ejection fraction less than 50 %). Conventional biochemical and hematological tests , ECG and echocardiography were performed. The level of the N-terminal fragment of the brain natriuretic peptide (NT-proBNP) and nonspecific inflammatory markers (C-reactive protein (CRP), fibrinogen, leukocytes, lymphocytes, neutrophil to lymphocyte ratio) were studied. Lactulose hydrogen breath test was fulfiled to detect the small intestinal bowel bacterial overgrowth syndrome (SIBOS). In the presence of complaints of palpitation and interruptions in the heart work or other indications, Holter ECG monitoring was performed. The control group consisted of 20 patients comparable to the main group by sex, age and major diseases in the absence of CHF and SIBOS.Results. The prevalence of SIBOS among patients with CHF significantly exceeded its prevalence in the group of patients without CHF (SIBOS was detected in 25 of 60 patients with CHF (42 %) and in 2 of 22 patients without CHF (9 %); p = 0.0034). The small bowel bacterial overgrowth syndrome with CHF did not have a significant impact on the functional class and the indicators of clinical and biochemical analysis of blood as well as on echocardiographic data and the number of supraventricular and ventricular extrasystoles. However, in patients with SIBOS, higher CRP values were observed (median and interquartile range: 3.6 (2.5; 4.1) vs 2.15 (0.4; 5.1); p = 0.041). In addition, among patients with CHF and a positive SIBOS test, ventricular tachycardia was significantly more common (in 45 % of patients with SIBOS and in 10.71 % of patients without SIBOS; p = 0.01555). The presence of SIBOS increased the risk of VT in patients with CHF (OR = 6.818, 95 % CI: 1.542 - 30.153; P = 0.011)). The development of VT in patients with SIBOS was associated rather with systemic inflammation than with the severity of CHF characterized by high NTproBNP numbers, while in the absence of SIBOS the opposite trend was noted.Conclusion. The development of VT in patients with SIBOS is associated rather with systemic inflammation rather than with the severity of CHF. SIBOS can be considered as an additional risk factor in the development of systemic inflammation and ventricular tachycardia in patients with CHF.

Tere are 44 patients (5 males and 39 females), aged 56 to 90 years were included in the study. To assess the tolerability and safety of the drug, undesirable events were recorded, associated and not associated with taking the drugwith taking the drug, a physical examination of patients was performed, an ECG was recorded and a biochemical blood test was performed at each visit of the patient to the center. During the observation period, two undesirable events chronologically associated with taking the drug were recorded During the study, none of the patients was excluded from the program due to the development of side effects and none of the patients refused to take the drug. We did not fnd any statistically signifcant increase in the incidence of cardiac pathology in patients taking the study drug, nor worsening of the already existing symptoms on the background of taking the drug for six months. Te observed growth trends in the level of blood creatinine a give grounds to recommend monitoring of kidney function in the patients taking the drug. In general, noogerone showed good tolerability, despite the elderly age of its patients and the high prevalence of concomitant somatic diseases in the sample.

Objective: Diagnostic and interventional cardiac catheterization procedures for congenital heart diseases (CHD) are becoming increasingly more popular, and arrhythmia is a well-known complication. This study was an evaluation of the incidence and causative agents of arrhythmia and the subsequent treatment strategies applied during cardiac catheterization. Methods: The catheterization data of all of the patients who underwent diagnostic cardiac catheterization for CHD between January 2012 and 2018 at a single center were examined retrospectively. Results: A total of 1316 children underwent diagnostic cardiac catheterization due to CHD. The median age and body weight was 18 months (6 days-21 years) and 9.9 kg (2.2–135 kg), respectively. Patients with ventricular septal defect (281 patients) and those with tetralogy of Fallot (257 patients) represented 2 major groups in the study population. In 93 (7%) patients, arrhythmia developed during cardiac catheterization. Among them, there were 58 (62%) cases of bradyarrhythmia and 35 (38%) cases of tachyarrhythmia. Arrhythmia was classified as low, high, or major, according to the adverse event severity score; the rates were 2.7%, 4.3%, and 1.2%, respectively. In 36 (39%) patients, there was no need for therapy, whereas 57 (61%) required treatment to eliminate the arrhythmia. Treatment modalities included catheter manipulation in 15, pharmacological therapy in 24, and cardioversion in 3 patients. Eleven patients required cardiopulmonary resuscitation. Temporary pacemaker implantation was required in 2 patients, while 2 others underwent permanent pacemaker implantation secondary to catheterization-related arrhythmia. There were no cases of mortality secondary to catheterization-related arrhythmia. Conclusion: Diagnostic cardiac catheterization in CHD may result in various types of cardiac arrhythmias. The proper management of arrhythmias may reduce morbidity and mortality related to cardiac catheterization.

Background: Home monitoring sensor systems are increasingly used to monitor seniors in their apartments for detection of emergency situations. The aim of this study was to deliver a proof-of-concept for the use of multimodal sensor systems with pervasive computing technology for the detection of clinically relevant health problems over longer time periods.Methods: Data were collected with a longitudinal home monitoring study in Switzerland (StrongAge Cohort Study) in a cohort of 24 old and oldest-old, community-dwelling adults over a period of 1 to 2 years. Physical activity in the apartment, toilet visits, refrigerator use, and entrance door openings were quantified using a commercially available passive infrared motion sensing system (Domosafety S.A., Switzerland). Heart rate, respiration rate, and sleep quality were recorded with the commercially available EMFIT QS bed sensor device (Emfit Ltd., Finland). Vital signs and contextual data were collected using a wearable sensor on the upper arm (Everion, Biovotion, Switzerland). Sensor data were correlated with health-related data collected from the weekly visits of the seniors by health professionals, including information about physical, psychological, cognitive, and behavior status, health problems, diseases, medication, and medical diagnoses.Results: Twenty of the 24 recruited participants (age 88.9 ± 7.5 years, 79% females) completed the study; two participants had to stop their study participation because of severe health deterioration, whereas two participants died during the course of the study. A history of chronic disease was present in 12/24 seniors, including heart failure, heart rhythm disturbances, pulmonary embolism, severe insulin-dependent diabetes, and Parkinson's disease. In total, 242,232 person-hours were recorded. During the monitoring period, 963 health status records were reported and repeated clinical assessments of aging-relevant indicators and outcomes were performed. Several episodes of health deterioration, including heart failure worsening and heart rhythm disturbances, could be captured by sensor signals from different sources.Conclusions: Our results indicate that monitoring of seniors with a multimodal sensor and pervasive computing system over longer time periods is feasible and well-accepted, with a great potential for detection of health deterioration. Further studies are necessary to evaluate the full range of the clinical potential of these findings.

Homeostatic regulation protects organisms against hazardous physiological changes. However, such regulation is limited in certain organs and associated biological processes. For example, the heart fails to self-restore its normal electrical activity once disturbed, as with sustained arrhythmias. Here we present proof-of-concept of a biological self-restoring system that allows automatic detection and correction of such abnormal excitation rhythms. For the heart, its realization involves the integration of ion channels with newly designed gating properties into cardiomyocytes. This allows cardiac tissue to i) discriminate between normal rhythm and arrhythmia based on frequency-dependent gating and ii) generate an ionic current for termination of the detected arrhythmia. We show in silico, that for both human atrial and ventricular arrhythmias, activation of these channels leads to rapid and repeated restoration of normal excitation rhythm. Experimental validation is provided by injecting the designed channel current for arrhythmia termination in human atrial myocytes using dynamic clamp.

Rhythm disturbances are life-threatening cardiovascular diseases, accounting for many deaths annually worldwide. Abnormal electrical activity might arise in a structurally normal heart in response to specific triggers or as a consequence of cardiac tissue alterations, in both cases with catastrophic consequences on heart global functioning. Preclinical modeling by recapitulating human pathophysiology of rhythm disturbances is fundamental to increase the comprehension of these diseases and propose effective strategies for their prevention, diagnosis, and clinical management. In silico, in vivo, and in vitro models found variable application to dissect many congenital and acquired rhythm disturbances. In the copious list of rhythm disturbances, diseases of the conduction system, as sick sinus syndrome, Brugada syndrome, and atrial fibrillation, have found extensive preclinical modeling. In addition, the electrical remodeling as a result of other cardiovascular diseases has also been investigated in models of hypertrophic cardiomyopathy, cardiac fibrosis, as well as arrhythmias induced by other non-cardiac pathologies, stress, and drug cardiotoxicity. This review aims to offer a critical overview on the effective ability of in silico bioinformatic tools, in vivo animal studies, in vitro models to provide insights on human heart rhythm pathophysiology in case of sick sinus syndrome, Brugada syndrome, and atrial fibrillation and advance their safe and successful translation into the cardiology arena.

The articles is devoted to role of the modern selective β-adrenergic blocker bisoprolol in therapy of angina, arterial hypertension, cardiac insufficiency, rhythm disturbance. The demonstrated effects of the drug include disease clinical manifestations reduction and decrease of cardiovascular incidence and mortality rates.

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Background: Despite impressive strides in diagnosis and management of acute myocardial infarction in the past three decades, acute myocardial infarction continues to be a major health problem. About 50% of death from acute myocardial infarction occur within 1 hour of the event and are attributable to arrhythmias most often ventricular fibrillation. Ischemic injury can produce conduction blocks at any level of the atrioventricular or Intraventricular conduction systems. Such conduction block can occur in the atrioventricular node producing various grades of AV block. Conduction block can occur in either main bundle branch producing right or left bundle branch block or in the anterior and posterior fascicle of left bundle branch, producing left anterior &left posterior fascicular blocks respectively. Aim of the Study: To study the incidence of rhythm disturbances in acute myocardial infarction, to evaluate the age, sex distribution and various other risk factors in relation to rhythm disturbances occurring in acute myocardial infarction, to correlate between the different types of rhythm disturbances in relation to the location and type of acute myocardial infarction. Materials and methods: The study was conducted in Government Dharmapuri Medical College Hospital during the period from November 2016 to May 2017. The patients admitted to ICCU were taken up for study. A detailed history physical examination &laboratory work up was done in all patients. Results: 100 Patients of acute myocardial infarction were included in this study. They consisted of 77 male and 23 female patients. The youngest patient was a 23 year old male and the oldest patient was an 84 year old male. Out of 100 patients with myocardial infarction 80 were males and 20 were females. Out of 80 males 37 had rhythm disturbances with a percentage of 46.25 and out of 20 females 9 had rhythm disturbance with a percentage of 45. 8 patients had previous ischemic heart disease prior to present episode. Of these 4 developed rhythm disturbances. All female patients were postmenopausal. 6 patients had COPD and 3 developed rhythm disturbances. Out of 100 patients 25 patients had Intraventricular block, of these right bundle branch block was common with an incidence of 10. Conclusion: The distribution of rhythm disturbances were almost equal in males and females (p value 0.3365). Rhythm disturbances were more common in the age group 50-59. The incidence of rhythm disturbances in patients with Diabetes mellitus and hypertension was high. [ABSTRACT FROM AUTHOR]

Chagas Disease (CD) is highly prevalent among the indigenous populations in the Sierra Nevada de Santa Marta, Colombia. Villages examined show prevalence rates ranging from 43.6% up to 67.4%. In the present study, associated medical conditions were assessed with a particular focus on ECG alterations. CD diagnosis was based on a rapid test, two different ELISAs, and a specific and highly sensitive Chagas real-time PCR. In both CD positive and CD negative patients, relations of the status and medical (physical examination-based, questionnaire-based) and/or electrocardiogram-based findings were investigated. As expected, CD-associated symptoms and complaints were predominantly found in CD-positive patients. Interestingly, ECG-findings were found to show the potential of leading to early CD diagnosis because ECG alterations were already seen in early stagechanges of the disease. In conclusion, although the observed ECG changes are unspecific, they should be considered as an indicator for a CD screening and, in case of positive results, an associated early treatment of the disease.

Answer questions and earn CME/CNE Cancer and heart disease are the leading causes of morbidity and mortality in the industrialized world. Modern treatment strategies have led to an improvement in the chances of surviving a diagnosis of cancer; however, these gains can come at a cost. Patients may experience adverse cardiovascular events related to their cancer treatment or as a result of an exacerbation of underlying cardiovascular disease. With longer periods of survival, late effects of cancer treatment may become clinically evident years or decades after completion of therapy. Current cancer therapy incorporates multiple agents whose deleterious cardiac effects may be additive or synergistic. Cardiac dysfunction may result from agents that can result in myocyte destruction, such as with anthracycline use, or from agents that appear to transiently affect left ventricular contractility. In addition, cancer treatment may be associated with other cardiac events, such as severe treatment-induced hypertension and vasospastic and thromboembolic ischemia, as well as rhythm disturbances, including QTc prolongation, that may be rarely life-threatening. Early and late effects of chest radiation can lead to radiation-induced heart disease, including pericardial disease, myocardial fibrosis, cardiomyopathy, coronary artery disease, valvular disease, and arrhythmias, in the setting of myocardial fibrosis. The discipline of cardio-oncology has developed in response to the combined decision making necessary to optimize the care of cancer patients, whether they are receiving active treatment or are long-term survivors. Strategies to prevent or mitigate cardiovascular damage from cancer treatment are needed to provide the best cancer care. This review will focus on the common cardiovascular issues that may arise during or after cancer therapy, the detection and monitoring of cardiovascular injury, and the best management principles to protect against or minimize cardiotoxicity during the spectrum of cancer treatment strategies. CA Cancer J Clin 2016;66:309-325. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the influence of physical stress in the «free selection mode» on the dynamics of heart rhythm disturbances, its variability and myocardial ischemia parameters in patients with myocardial infarction (MI) on the stage of rehabilitation in special facilities. 75 patients admitted to the facility for rehabilitation treatment on days 19-38 following acute MI have been studied, divided into 2 groups: the basic one, with patients using veloergometry training with the mode of free selection of stress parameters; and the comparison group using no veloergometry training in treatment. All patients underwent physical rehabilitation programme, dose-adjusted walking, climbing stairs, physical training. Upon admission and at the discharge from the facility patients underwent 24-hours Hotter ECG monitoring. The inclusion of veloergometry training with the mode of free selection of stress parameters in the special facilities rehabilitation complex promotes restoration of vegetative balance and increases activity of parasympathetic autonomous nervous system, exerting protective action and increasing myocardial electrical stability, veloergometry training with the mode of free selection of stress parameters have been established to exert antiarrhythmic influence, decrease the prevalence of potentially hazardous high grade ventricular premature beats, decrease myocardial ischemia.

Rhythm disturbances are life-threatening cardiovascular diseases, accounting for many deaths annually worldwide. Abnormal electrical activity might arise in a structurally normal heart in response to specific triggers or as a consequence of cardiac tissue alterations, in both cases with catastrophic consequences on heart global functioning. Preclinical modeling by recapitulating human pathophysiology of rhythm disturbances is fundamental to increase the comprehension of these diseases and propose effective strategies for their prevention, diagnosis, and clinical management. In silico, in vivo, and in vitro models found variable application to dissect many congenital and acquired rhythm disturbances. In the copious list of rhythm disturbances, diseases of the conduction system, as sick sinus syndrome, Brugada syndrome, and atrial fibrillation, have found extensive preclinical modeling. In addition, the electrical remodeling as a result of other cardiovascular diseases has also been investigated in models of hypertrophic cardiomyopathy, cardiac fibrosis, as well as arrhythmias induced by other non-cardiac pathologies, stress, and drug cardiotoxicity. This review aims to offer a critical overview on the effective ability of in silico bioinformatic tools, in vivo animal studies, in vitro models to provide insights on human heart rhythm pathophysiology in case of sick sinus syndrome, Brugada syndrome, and atrial fibrillation and advance their safe and successful translation into the cardiology arena. [ABSTRACT FROM AUTHOR]

Background: Home monitoring sensor systems are increasingly used to monitor seniors in their apartments for detection of emergency situations. The aim of this study was to deliver a proof-of-concept for the use of multimodal sensor systems with pervasive computing technology for the detection of clinically relevant health problems over longer time periods. Methods: Data were collected with a longitudinal home monitoring study in Switzerland (StrongAge Cohort Study) in a cohort of 24 old and oldest-old, community-dwelling adults over a period of 1 to 2 years. Physical activity in the apartment, toilet visits, refrigerator use, and entrance door openings were quantified using a commercially available passive infrared motion sensing system (Domosafety S.A., Switzerland). Heart rate, respiration rate, and sleep quality were recorded with the commercially available EMFIT QS bed sensor device (Emfit Ltd., Finland). Vital signs and contextual data were collected using a wearable sensor on the upper arm (Everion, Biovotion, Switzerland). Sensor data were correlated with health-related data collected from the weekly visits of the seniors by health professionals, including information about physical, psychological, cognitive, and behavior status, health problems, diseases, medication, and medical diagnoses. Results: Twenty of the 24 recruited participants (age 88.9 ± 7.5 years, 79% females) completed the study; two participants had to stop their study participation because of severe health deterioration, whereas two participants died during the course of the study. A history of chronic disease was present in 12/24 seniors, including heart failure, heart rhythm disturbances, pulmonary embolism, severe insulin-dependent diabetes, and Parkinson's disease. In total, 242,232 person-hours were recorded. During the monitoring period, 963 health status records were reported and repeated clinical assessments of aging-relevant indicators and outcomes were performed. Several episodes of health deterioration, including heart failure worsening and heart rhythm disturbances, could be captured by sensor signals from different sources. Conclusions: Our results indicate that monitoring of seniors with a multimodal sensor and pervasive computing system over longer time periods is feasible and well-accepted, with a great potential for detection of health deterioration. Further studies are necessary to evaluate the full range of the clinical potential of these findings., (Copyright © 2020 Saner, Schütz, Botros, Urwyler, Buluschek, du Pasquier and Nef.)

Homeostatic regulation protects organisms against hazardous physiological changes. However, such regulation is limited in certain organs and associated biological processes. For example, the heart fails to self-restore its normal electrical activity once disturbed, as with sustained arrhythmias. Here we present proof-of-concept of a biological self-restoring system that allows automatic detection and correction of such abnormal excitation rhythms. For the heart, its realization involves the integration of ion channels with newly designed gating properties into cardiomyocytes. This allows cardiac tissue to i) discriminate between normal rhythm and arrhythmia based on frequency-dependent gating and ii) generate an ionic current for termination of the detected arrhythmia. We show in silico, that for both human atrial and ventricular arrhythmias, activation of these channels leads to rapid and repeated restoration of normal excitation rhythm. Experimental validation is provided by injecting the designed channel current for arrhythmia termination in human atrial myocytes using dynamic clamp., Competing Interests: RM, TD, NK, AV, IK, BÖ, NH, RW, Ad, DY, AP, DP No competing interests declared, (© 2020, Majumder et al.)

Chronic obstructive pulmonary disease (COPD) is а highly prevalent, complex and heterogeneous clinical condition which is associated with significant concomitant diseases. COPD and cardiovascular diseases (CVDs) often coexist due to the high prevalence of each of these pathological conditions separately as well as the common risk factors (particularly smoking), mechanisms of interaction and influence of systemic inflammation. In addition, decreased pulmonary function in COPD is closely associated with an increased risk of congestive CVDs. One of the most important pathophysiological markers of COPD-lung hyperinflation-plays a significant role in the appearance of functional limitations of the pumping function of the heart, creating unfavorable conditions by exerting a compression effect on the heart muscle. The latter was confirmed by significant correlation between the COPD severity according to GOLD classification and the basic dimensions of the heart chambers. Several decades ago, the term "microcardia" was commonly used and indicated a radiological sign of emphysema. Some studies demonstrated a close relationship between the chance of occurrence of CVD and the severity of pulmonary dysfunction. Such an association has been demonstrated for the whole spectrum of CVD-including cerebrovascular disease, congestive heart failure (CHF) and rhythm disturbances-and was detected in the early stages of the disease. A large proportion of patients with mild and moderate COPD die due to CVD, which is much more likely than deaths in the same group due to respiratory insufficiency. COPD patients have a higher rate of hospitalization and death, the cause of which are coronary heart disease (CHD), stroke and CHF. Treatment of COPD today is mainly determined by national and international clinical guidelines, which should pay more attention to the problems of the treatment of COPD patients with comorbid conditions., Competing Interests: Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.03.60). The series “GARD Section” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare., (2020 Journal of Thoracic Disease. All rights reserved.)

Background: We aimed to evaluate rhythm abnormalities in cases of congenitally corrected transposition of the great arteries (ccTGA) and associated treatment strategies., Patients and Methods: This retrospective cohort study included 65 pediatric patients with ccTGA who were admitted to the clinic between 2009 and 2017. The patients were divided into two groups, and surgical data, Holter electrocardiographic (ECG) recordings, ECG recordings, electrophysiological data, and device implantation data on the two groups were compared., Results: Group I (n = 53, 82%) consisted of patients with significant associated lesions, and Group II (n = 12, 18%) consisted of those with minor or no associated lesions (isolated ccTGA). Rhythm abnormalities were diagnosed in 22 (34%) of the patients based on initial ECG findings and Holter ECG recordings. Eleven (17%) of these patients had atrioventricular (AV) block of different degrees, and the other 11 (17%) had supraventricular arrhythmia (SVA). The median follow-up was 49 months (range, 9-89 months), and the rhythm remained normal in 26 (42%) of the patients. Three patients died on follow-up. Of 40 patients with normal initial findings, nine required pacemaker implantation due to complete heart block, and SVA developed in seven patients on follow-up. No ventricular tachycardia was seen initially or on follow-up. Ablation was performed in four patients. During the follow-up period, pacemakers were implanted in 12 (23%) of patients in Group I and 4 (33%) of patients in Group II due to complete heart block. Cardiac resynchronization therapy (CRT) was performed in four patients due to systemic ventricular dysfunction. Notably, all four of these patients had a pacemaker implanted postoperatively., (© 2018 Wiley Periodicals, Inc.)