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Purpose Current recommendations for antithrombotic therapy for continuous-flow left ventricular assist device (CF-LVAD) include both anticoagulant and antiplatelet therapy to prevent detrimental thromboembolic (TE) complications. This also results in high incidence of bleeding complications in this population. Several studies have reported favorable outcomes of anticoagulant therapy without antiplatelet therapy to reduce bleeding complications in patients supported with CF-LVADs. Methods We performed a comprehensive literature search through September 2018 using MEDLINE, EMBASE, Scopus and the Cochrane Library. Included studies were prospective or retrospective cohort studies that reported outcomes of CF-LVADs with no antiplatelet therapy. Results Four studies (2 prospective cohort studies, 2 retrospective cohort studies) with 198 patients were included in this study; all patients had Heartmate II devices. Median age was 58 years and 92% were men. All patients received oral vitamin K antagonist for anticoagulation with median INRs of 1.85-2.59. Over median follow-up period of 17 months (range 1-2 years), 5.4% (range 0-7%) had device thrombosis, 4.9% (range 2-7.4%) had ischemic stroke and 21.5% (range 15-37%) had bleeding complications. Hemorrhagic stroke of 4% reported in one study. Conclusion Anticoagulant therapy without antiplatelet therapy in CF-LVAD population may help reduce the incidence of bleeding complications without increasing the risk of TE events. This should be taken into consideration when choosing anticoagulation strategy especially in patients at high risk of bleeding.

Background Brugada syndrome (BrS) is defined as presenting of type-1 Brugada pattern (BrP). BrS can also be induced by fever. This study demonstrated a highest prevalence of fever-induced BrS ever reported. Method During May 2014, febrile (oral temperature ≥ 38 °C) and nonfebrile patients underwent standard and high leads (V1 and V2 at 2nd intercostal space) electrocardiogram. Risk factor and cardiac symptoms were recorded. Patients with a persistent of type-1 BrP after fever had subsided were excluded. The prevalence of BrS, type-2 BrP and early repolarization pattern (ERP) were demonstrated. Results A total of 401 patients, 152 febrile, and 249 nonfebrile, were evaluated. BrS was identified in six febrile patients (five males and one female) and two males in nonfebrile patients. The study demonstrated higher prevalence of BrS in febrile group compared to nonfebrile group (4.0% vs 0.8%, respectively, P = 0.037). Among fever-induced BrS patients, three patients (50.0%) experienced cardiac symptoms before and at the time of presentation and two patients (33.3%) had history of first-degree relative sudden death. No ventricular arrhythmia was observed. All of type-1 BrP disappeared after fever had subsided. We found no difference in prevalence of type-2 BrP in febrile and nonfebrile group (2.0% vs 2.8%, respectively, P > 0.05) as well as ERP (3.3% vs 6.4%, respectively, P > 0.05). Conclusions Our study showed a highest prevalence of fever induced BrS ever reported. A larger study of prevalence, risk stratification, genetic test and management of fever-induced BrS should be done, especially in an endemic area.

BACKGROUND: Fragmented QRS reflects disturbances in the myocardium predisposing the heart to ventricular tachyarrhythmias. Recent studies suggest that fragmented QRS (fQRS) is associated with worse major arrhythmic events in hypertrophic cardiomyopathy (HCM). However, a systematic review and meta‐analysis of the literature has not been done. We assessed the association between fQRS and major arrhythmic events in hypertrophic cardiomyopathy by a systematic review of the literature and a meta‐analysis. METHODS: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2017. Included studies were published prospective or retrospective cohort studies that compared major arrhythmic events (sustained ventricular tachycardia, sudden cardiac arrest, or sudden cardiac death) in HCM with fQRS versus non‐fQRS. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. RESULTS: Five studies from January 2013 to May 2017 were included in this meta‐analysis involving 673 subjects with HCM (205 fQRS and 468 non‐fQRS). Fragmented QRS was associated with major arrhythmic events (pooled risk ratio = 7.29, 95% confidence interval: 4.00–13.29, p

BACKGROUND: Fragmented QRS reflects disturbances in the myocardium predisposing the heart to ventricular tachyarrhythmias. Recent studies suggest that fragmented QRS (fQRS) is associated with major arrhythmic events in Brugada syndrome. However, a systematic review and meta‐analysis of the literature has not been done. We assessed the association between fQRS and major arrhythmic events in Brugada syndrome by a systematic review of the literature and a meta‐analysis. METHODS: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2017. Included studies were published prospective or retrospective cohort studies that compared major arrhythmic events (ventricular fibrillation, sustained ventricular tachycardia, sudden cardiac arrest, or sudden cardiac death) in Brugada syndrome with fQRS versus normal QRS. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. RESULTS: Nine studies from January 2012 to May 2017 were included in this meta‐analysis involving 2,360 subjects with Brugada syndrome (550 fQRS and 1,810 non‐fQRS). Fragmented QRS was associated with major arrhythmic events (pooled risk ratio =3.36, 95% confidence interval: 2.09‐5.38, p

Recent studies suggest that atrial fibrillation (AF) is associated with increased cardiovascular risk and mortality including sudden cardiac death (SCD). According to the Cardiovascular Heath Study cohort, the incident rate of SCD was higher in the AF population (2.9 per 1000 per year) compared with non-AF controls (1.3 per 1000 per year). In this study, we performed a systematic review and meta-analysis to explore the association between AF and SCD. We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2017. Included studies were published prospective or retrospective cohort studies that compared the risk of developing SCD, defined by World Health Organization’s criteria, in AF patients versus non-AF patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the risk ratios and 95% confidence intervals. Twenty-seven studies from January 1991 to February 2017 involving 8401 AF patients and 67,608 non-AF controls were included in this meta-analysis. Compared with controls, AF patients had a significantly higher risk of SCD in overall analysis (pooled risk ratio = 2.04, 95% confidence interval: 1.77–2.35, p

Chronic total coronary occlusion (CTO) management remains a challenge. Several studies have reported the benefits of percutaneous coronary intervention (PCI) in CTO. However, the outcomes of PCI versus optimal medical therapy (OMT) are still controversial. We comprehensively searched the databases

Purpose Thromboembolism (TE) is common after left ventricular assist device (LVAD) implantation and early anticoagulation (AC) bridging to therapeutic international normalized ratio (INR) has been widely implemented to prevent this complication. However, some studies suggested that no early AC bridging after LVAD implantation decreases bleeding complications without increase in incidence of TE. This meta-analysis aimed to evaluate the association between early AC bridging after LVAD implantation and incidence of TE and bleeding complications. Methods We performed a comprehensive literature search through September 2018 using MEDLINE and EMBASE. Included studies were prospective or retrospective cohort studies that compared the incidence of TE and bleeding in LVAD patients with and without early AC bridging to therapeutic INR. We calculated pooled odds ratio (OR) with 95% confidence intervals (CI) and I2 statistic using the random-effects model. Results Six studies were included in this meta-analysis. All patients had continuous-flow LVADs implanted. TE events were reported in 6 studies involving 897 patients (611 with bridging, 286 without bridging). Bleeding complications were reported in 4 studies involving 623 patients (405 with bridging, 218 without bridging). Median follow-up was 3.5 months. There was no association between AC bridging and incidence of TE (RR: 0.68; 95% CI: 0.41-1.12, I2=0%) and bleeding complications (RR: 0.98; 95% CI: 0.61-1.57, I2=32%) (Figure). Conclusion Our meta-analysis suggests that early AC bridging to therapeutic INR after LVAD implantation is not associated with decreased TE and increased bleeding complications. Controlled trials are warranted to further investigate the utility of early AC bridging after LVAD implantation in patients at high risk for TE complications.

Long-term use of oral beta-blocker(BB) was known to have a potential benefit in patients with acute myocardial infarction (AMI). However, all the trials were done predating the era of reperfusion. Last 2 decades, primary percutaneous coronary intervention (PCI) has been shown to decrease the

Recent studies suggest that implantable cardioverter defibrillator (ICD) is associated with increased risk of cardiac implantable electronic device (CIED) infection when compared to permanent pacemaker (PPM). However, there were controversies among previous studies. We performed a systematic review

Changing in size, density, and reactivity of platelets play an important role in occurrence and progression of myocardial infarction. Increased mean platelet volume (MPV) increases the incidence of fibrinolytic failure in ST segment elevation myocardial infarction (STEMI). Electrocardiographic

We report the death of an infant due to severe sepsis caused by congenital tuberculosis following treatment with antituberculous drugs and antibiotics, who was born to a mother with misdiagnosed symptomatic pulmonary tuberculosis during pregnancy. Therefore, pregnant women with chronic cough and constitutional symptoms must be examined for pulmonary tuberculosis, particularly in tuberculosis endemic areas.

Brugada syndrome is an inherited arrhythmic disease associated with sudden cardiac death. The clinical manifestations of Brugada syndrome vary and include ventricular fibrillation, ventricular tachycardia, sudden cardiac death, syncope, nocturnal agonal respiration, palpitations, or chest pain.

INTRODUCTION: Contrast‐induced nephropathy (CIN) is associated with increased cardiovascular morbidity and mortality in patients with acute coronary syndrome (ACS). Recent studies suggest that CIN is associated with new‐onset atrial fibrillation (AF) in patients with acute coronary syndrome (ACS) who underwent catheterization. However, a systematic review and meta‐analysis of the literature have not been done. We assessed the association between CIN in patients with ACS and new‐onset AF by a systematic review of the literature and a meta‐analysis. HYPOTHESIS: CIN is associated with new‐onset AF in patients with ACS. METHODS: We comprehensively searched the databases of MEDLINE and EMBASE from inception to April 2018. Included studies were published cohort studies that compared new‐onset AF after cardiac catheterization in ACS patient with CIN versus without CIN. Data from each study were combined using the random effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. RESULTS: Five studies from December 2009 to February 2018 were included in this meta‐analysis involving 5,640 subjects with ACS (1,102 with CIN and 4,538 without CIN). Contrast‐induced nephropathy significantly correlates with new‐onset AF after cardiac catheterization (pooled risk ratio = 2.84, 95% confidence interval: 1.66–4.87, p

INTRODUCTION: Atrial fibrillation (AF) is known as the most common arrhythmia and an independent risk factor for mortality. Recent studies suggest that AF is associated with morbidity and mortality in Takotsubo cardiomyopathy (TTC). However, a systematic review and meta‐analysis of the literature have not been done. We assessed the association between AF in patients with TTC and mortality by a systematic review of the literature and a meta‐analysis. METHODS: We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2018. Included studies were published prospective or retrospective cohort studies that compared all‐cause mortality in TTC with AF versus without AF. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. RESULTS: Five studies from August 2008 to October 2017 were included in this meta‐analysis involving 2,321 subjects with TTC (243 with AF and 2,078 without AF). The presence of AF was associated with all‐cause mortality (pooled odds ratio = 2.19, 95% confidence interval: 1.57–3.06, p

BACKGROUND: Fragmented QRS reflects disturbances in the myocardium predisposing the heart to ventricular tachyarrhythmias. Recent studies suggest that fragmented QRS (fQRS) is associated with mortality in ST‐elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, a systematic review and meta‐analysis of the literature has not been done. We assessed the association between fQRS and overall mortality in STEMI patients who subsequently underwent PCI by a systematic review and meta‐analysis. METHODS: We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Studies included in our analysis were published cohort (prospective or retrospective) and case–control studies that compared overall mortality among STEMI patient with and without fQRS who underwent PCI. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian, and Laird to calculate risk ratios and 95% confidence intervals. RESULTS: Six studies from 2014 to 2017 were included in this meta‐analysis involving 2,516 subjects with STEMI who underwent PCI (888 fQRS and 1,628 non‐fQRS). Fragmented QRS was associated with overall mortality in STEMI patients who underwent PCI (pooled risk ratio = 3.87; 95% CI 1.96–7.66, I (2) = 43%). CONCLUSION: Fragmented QRS was associated with increased overall mortality up to threefold. Our study suggests that fQRS could be an important tool for risk assessment in STEMI patients who underwent PCI.

Fragmented QRS (fQRS) reflects disturbances in the myocardium predisposing the heart to ventricular tachyarrhythmias. Recent studies suggest that fQRS is associated with increased mortality in ST elevation myocardial infarction (STEMI) patients whounderwent percutaneous intervention (PCI). However

Brugada syndrome (BrS) is an autosomal dominant inherited arrhythmic disease associated with the SCN5A mutation. Recent studies suggest that SCN5A mutation is associated with major arrhythmic events (MAE) in BrS which is controversial in previous studies. However, a systematic review and meta

Recent studies suggested that chronic total occlusion of the coronary artery increased risk of ventricular arrhythmia (VA) and all-cause mortality in ischemic cardiomyopathy (ICM) patient who underwent implantable cardiac defibrillator (ICD) implantation. We aim to determine adverse events in this

Atrial fibrillation (AF) is one of the most comorbid conditions in critically ill patients requiring intensive care unit (ICU). Multiple studies have suggested that there may be an association between new-onset AF and adverse outcome in critically ill patients. However, there are no meta-analyses to assess this association.Studies were systematically searched from electronic databases. Studies that examined the relationship between new-onset AF and adverse outcomes including mortality and length of stay in ICU patients were included. Studies that included patients with prior AF were excluded. The pooled effect size was calculated with a random-effect model, weighted for the inverse of variance, to determine an association between new-onset AF and in-hospital mortality. Heterogeneity was assessed with ITwelve studies were included. Pooled analysis showed statistically significant difference rate of the hospital mortality between patients with and without new-onset AF (OR 2.70; 95% CI 2.43-3.00). Subgroup analysis of only patients with sepsis or septic shock showed a significant association between new-onset AF and in-hospital mortality (OR 2.32; 95% CI 1.88-2.87). No significant heterogeneity was observed (INew-onset AF is associated with worse outcome in critically ill patients. Further studies should be done to evaluate for causality and adjust for confounders.

Chronic total occlusion (CTO) management remains a challenge. Several studies have reported the benefits of percutaneous coronary intervention (PCI) in CTO. However, the outcomes of PCI versus optimal medical therapy (OMT) are still controversial. We conducted extensive reviews and meta-analysis to

Frequent supraventricular premature complexes (SPVCs) are associated with higher morbidity and mortality. Recent studies suggest that frequent SPVCs is associated with new onset atrial fibrillation (AF). However, a systematic review and meta-analysis of the literature has not been done. We assessed

Vasovagal syncope (VVS) is defined by transient loss of consciousness with spontaneous rapid recovery. Recently, a closed loop stimulation pacing system (CLS) has shown superior effectiveness to conventional pacing in refractory VVS. However, there have been no systematic review and meta-analysis.

Transcatheter aortic valve replacement (TAVR) is a treatment option for patients with severe aortic stenosis (AS) with high surgical risk. Anemia is a common comorbidity in the TAVR population. Small studies have suggested that anemia is associated long-term mortality in patients who underwent TAVR

Atrial fibrillation (AF) is commonly found in candidates of left ventricular assist device (LVAD). A large INTERMACS study suggests that AF may not increase mortality on midterm follow-up (median time 8.5 months; IQR 4.6-13.5 months), while some of the other studies that follow the patients longer

Introduction: Sudden unexpected death (SUD) is the leading cause of death worldwide. Although coronary atherosclerosis is a major cause of SUD, standard autopsy may not explain the cause of SUD. The frequency of unidentified cause of death in Thailand is not known. Therefore, we conduct a retrospective study to address the frequency of unidentified cause of death in SUD of Thailand. Hypothesis: The frequency of unidentified cause of death in SUD of Thailand could be higher than Caucasian. Methods: We reviewed autopsy reports of SUD in Ramathibodi Hospital, Mahidol University, Thailand, during January 2012-December 2013. The autopsy reports were excluded if; (1) the age was over 65 or under 18 years; (2) the death was expected death: e.g. the decease was in hospice care; (3) the cause was an obvious non-cardiac cause: e.g. trauma, overdose, or pneumonia; (4) the decease was not Thai citizen. Results: A total of 116 cases, 108 males (93.1%) and 8 female (6.9%), were included. The mean age was 49.7±15.2 years. The cause of death was identified as ischemic heart disease in 74 cases (63.8%), which 32 cases (27.6%) were significant coronary atherosclerosis without infarction, 23 cases (19.8%) were acute myocardial infarction, and 19 cases (16.4%) were old myocardial scaring. The causes of death were due to myocardial bridging in 8 cases (6.9%), isolated left ventricular hypertrophy in 6 cases (5.2%), hypertrophic cardiomyopathy in 3 cases (2.6%), and myocarditis in 2 cases (1.7%). Other causes were 1 case (0.9%) of obesity cardiomyopathy, 1 case (0.9%) of aortic stenosis, and 1 case (0.9%) of dilated cardiomyopathy. Interestingly, the cause of death was not clearly identified in 20 cases (17.2%) from standard autopsy, including 5 cases (4.3%) without any co-morbidity, 6 cases (5.2%) with non-significant atherosclerosis, 4 cases (3.4%) with non-toxic level of prescribed drugs, 3 cases (2.6%) with non-toxic level of alcohol, and 2 cases (1.7%) with history of epilepsy. Conclusions: We demonstrated higher frequency of unidentified cause of death in Thai SUD compared to Caucasian, as well as frequency of myocardial bridging. However, the frequency of ischemic heart disease was lower. Further incidence study and molecular autopsy of SUD should be conducted in Asian population.

Bariatric surgery is found to prevent type 2 diabetes, improve glycemic control, and decrease long-term incidence of microvascular and macrovascular complications in obese persons. However, its effect on urinary albumin excretion (UAE) in patients with diabetic nephropathy (DN) is still unknown. This is a systematic review and meta-analysis of observational studies on bariatric surgery and change in UAE in patients with diabetes.To explore whether there is improvement in UAE after bariatric surgery.We comprehensively searched the databases of MEDLINE, Embase, and Cochrane. The inclusion criteria were published studies evaluating effects of bariatric surgery in patients with DN at baseline. The primary outcome was the pre- and postbariatric surgery UAE as characterized by urinary albumin-to-creatinine ratio and albuminuria. A meta-analysis comparing pre- and postsurgery UAE was performed.From 65 full-text articles, 15 observational studies met our inclusion criteria, and 11 studies were included in the meta-analysis based on the random effects model. There was a significant reduction in urinary albumin-to-creatinine ratio after bariatric surgery with a mean difference of -6.60 mg/g of creatinine (95% CI -9.19 to -4.02; P.001). There was also a reduction in albuminuria with a mean difference of -55.76 mg/24 hours (95% CI -92.11 to -19.41; P.001) after bariatric surgery.Bariatric surgery significantly decreases urinary albumin excretion in DN. However, studies comparing bariatric surgery and conventional or intensive care of diabetes on UAE outcome should be done.

Atrial fibrillation(AF) has been known to increase complications after medical procedures. We aim to determine the effect of pre-existing atrial fibrillation on patients who underwent transcatheter aortic valve replacement (TAVR). Databases were searched from inception through June 2017. The

Background: Brugada syndrome (BrS) is reported to be an important etiology of sudden cardiac death in Asian population. Prevalence of BrS has been reported in various regions, countries, and ethnicities. Our study is the first systematic review and meta-analysis assessing worldwide prevalence of BrS

To the Editor: A preoperative ECG of a febrile (38.0 C) 56-year-old Thai man diagnosed with acute appendicitis revealed type1 Brugada pattern (BrP) (Fig. 1a). His ECG was repeated at 15 and 30 min, which showed type-2 BrP (Fig. 1b). The patient denied clinical manifestations or family history of Brugada syndrome (BrS). He was diagnosed with asymptomatic BrS. Many asymptomatic BrS unmasked by fever have been reported. Moreover, fever has also triggered ventricular arrhythmias [1]. Electrophysiological study or drug challenge test should be done to stratify the risk of arrhythmias in asymptomatic BrS [2]. However, it is not suitable to perform such a test before emergency operation. Therefore, to avoid exacerbation of ventricular arrhythmias, class IC/ IA antiarrhythmic drugs, epidural bupivacaine, acetylcholine, propranolol, propofol, pinacidil, and nicorandil should not be used [3]. In our case, by using general anesthesia, intravenous etomidate was used for induction and seroflurane was used for maintenance. Rocuronium was used as a muscle relaxant. ECG was monitored and external defibrillator was installed for the entire operation. The patient uneventfully went to an appendectomy. His ECG was normal during non-febrile state (Fig. 1c).

Intracranial hemorrhage (ICH) is one of the most common non-cardiac causes of sudden unexpected death (SUD). In western population, subarachnoid hemorrhage (SAH) is the most common etiology (51.3%) of ICH followed by hypertensive intracerebral hemorrhage (HICH) (18.8%). However, the frequency of SAH

Brugada syndrome (BrS) is defined as presenting of type-1 Brugada pattern (BrP). BrS can also be induced by fever. We reported a high prevalence of fever induced BrS from the emergency department of Buriram hospital, Thailand. This study demonstrated the highest prevalence of fever induced BrS ever

Introduction There is inconclusive evidence whether osteoporosis increases risk of hearing loss in current literature. Objective We conducted this meta-analysis to determine whether there is an association between hearing loss and osteoporosis. Methods This systematic review and meta-analysis was conducted from studies of MEDLINE, EMBASE, and LILACS. Osteoporosis was defined as having a bone mineral density with a T-score of less than −2.5 standard deviation. The outcome was hearing loss as assessed by audiometry or self-reported assessment. Random-effects model and pooled hazard ratio, risk ratio, or odds ratio of hearing loss with 95% confidence intervals were compared between normal bone mineral density and low bone mineral density or osteoporosis. Results A total of 16 articles underwent full-length review. Overall, there was a statistically significant increased odds of hearing loss in the low bone mineral density or osteoporosis group with odds ratio of 1.20 (95% confidence intervals 1.01–1.42, p = 0.04, I2 = 82%, Pheterogeneity = 0.01). However, the study from Helzner et al. reported significantly increase odds of hearing loss in the low bone mineral density in particular area and population included femoral neck of black men 1.37 (95% confidence intervals 1.07–1.76, p = 0.01) and total hip of black men 1.36 (95% confidence intervals 1.05–1.76, p = 0.02). Conclusion Our study proposed the first meta-analysis that demonstrated a probable association between hearing loss and bone mineral density. Osteoporosis could be a risk factor in hearing loss and might play an important role in age-related hearing loss.

Background Recent studies suggested that variants on chromosome loci 4q25, 1q21, and 16q22 were associated with atrial fibrillation recurrence after catheter ablation. In this study, we performed a systematic review and meta-analysis to explore the association between variants on chromosome loci 4q25, 1q21, and 16q22 and atrial fibrillation recurrence after catheter ablation. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2017. Included studies were published prospective or retrospective cohort and case control studies that compared the risk of atrial fibrillation recurrence after catheter ablation in AF patients with chromosome 4q25, 1q21, and 16q22 variants versus no variants. Single-nucleotide polymorphism rs1906617, rs2106261, rs7193343, rs2200733, rs10033464, rs13376333, and rs6843082 were included in this analysis. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the risk ratios and 95% confidence intervals. Results Seven studies from January 2010 to June 2017 involving 3,322 atrial fibrillation patients were included in this meta-analysis. According to the pooled analysis, there was a strong independent association between chromosome 4q25 variant (rs2200733) and the risk of atrial fibrillation recurrence after catheter ablation (risk ratio 1.45 [95% confidence interval 1.15-1.83], P = 0.002). No association was found in other variants. Conclusion Our meta-analysis demonstrates a statistically significant increased risk of atrial fibrillation recurrence after catheter ablation in 4q25 variant (only in rs2200733) but not in 1q21 or 16q22 variants.