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To investigate the clinical characteristics of Guillain–Barré syndrome (GBS) in patients with primary Sjögren's syndrome (SS). Records of patients with positive anti-SSA antibodies hospitalized in the Beijing Tiantan Hospital between December 2011 and May 2020 were retrieved. Patients who fulfilled the criteria for diagnosis of GBS and primary SS were included, and their clinical data were analyzed. Among the 785 patients with positive anti-SSA, 52 patients were identified in this study. They were 27 males and 25 females with median age of 59 years old. Besides anti-SSA antibodies, multiple autoantibodies were detected in these patients including antinuclear antibody, anti-Ro52, anti-mitochondrial M2, anti-thyroid peroxidase and anti-thyroglobulin autoantibodies. Preceding infection was reported in 42 patients. Hyporeflexia/areflexia and limbs weakness were the most common manifestation and 35 patients presented cranial nerve injuries. GBS disability score of 3, 4 and 5 was scaled in 28 (53.8%), 15 (28.8%) and 3 (5.8%) patients respectively. Forty-six patients received intravenous immunoglobulin (IVIG) monotherapy, 5 patients were treated by IVIG plus glucocorticoids, and 51 patients improved during hospitalization. The frequency of male gender among the patients with both GBS and primary SS suggests an independent onset of GBS and the co-existence of these autoimmune diseases in patients with multiple autoantibodies. Majority of patients with GBS and primary SS experience benign disease course. [ABSTRACT FROM AUTHOR]

Disorders of the cardiac rhythm may occur in both the fetus and neonate. Because of the immature myocardium, the hemodynamic consequences of either bradyarrhythmias or tachyarrhythmias may be far more significant than in mature physiological states. Treatment options are limited in the fetus and neonate because of limited vascular access, patient size, and the significant risk/benefit ratio of any intervention. In addition, exposure of the fetus or neonate to either persistent arrhythmias or antiarrhythmic medications may have yet-to-be-determined long-term developmental consequences. This scientific statement discusses the mechanism of arrhythmias, pharmacological treatment options, and distinct aspects of pharmacokinetics for the fetus and neonate. From the available current data, subjects of apparent consistency/consensus are presented, as well as future directions for research in terms of aspects of care for which evidence has not been established. [ABSTRACT FROM AUTHOR]

Objective: The present study compared the clinical features of patients with primary Sjögren's syndrome (pSS) with and without nephrolithiasis and/or nephrocalcinosis to determine factors related to renal dysfunction. Methods: The clinical features of 68 patients with anti-Sjogren's syndrome antigen A (SSA)/Ro-antibody–positive pSS with and without nephrolithiasis and/or nephrocalcinosis who underwent abdominal computed tomography and/or ultrasonography were retrospectively analysed. Results: Of the 68 patients with anti-SSA-antibody–positive pSS, 23 (33%) had renal nephrolithiasis and/or nephrocalcinosis, whereas 45 (67%) did not. Fourteen (20%) patients had renal dysfunction at diagnostic imaging. Among five patients who underwent renal biopsy, four patients with renal nephrolithiasis and/or nephrocalcinosis were diagnosed with tubulointerstitial nephritis, and one without nephrolithiasis and/or nephrocalcinosis was diagnosed with minimal change nephrotic syndrome. Estimated glomerular filtration rate at diagnostic imaging was significantly lower in patients with than without nephrolithiasis and/or nephrocalcinosis group (P = 0.010). In addition to nephrolithiasis and/or nephrocalcinosis (odds ratio [OR], 3.467; P = 0.045), the gap between serum sodium and chloride concentrations (OR, 10.400; P = 0.012) and increased urinary β2-microglobulin (OR, 5.444; P = 0.033) were associated with renal dysfunction at the time of diagnostic imaging. Conclusion: Nephrolithiasis and/or nephrocalcinosis, normal anion gap metabolic acidosis, and tubulointerstitial damage are associated with renal dysfunction in patients with pSS. [ABSTRACT FROM AUTHOR]

Background: Left ventricular outflow tract obstruction (LVOTO) impairs survival and diminishes quality of life in patients with hypertrophic obstructive cardiomyopathy (HOCM). In this study, we aimed to investigate the safety and the efficacy of earlier alcohol septal ablation (ASA) in patients with HOCM. Methods: A total of 47 patients with mildly symptomatic HOCM (NYHA II) and having poor functional capacity despite maximal tolerated medical therapy were included. Results: The mean age of the patients was 55 ± 14, and 57% of the patients were male. All clinical endpoint targets including 30 d mortality (1% vs. 0% p < 0.01), 30 d adverse complications (10% vs. 0% p < 0.01), 30 d complete heart block resulting in need for permanent pacemaker (10% vs. 4.2% p < 0.01), more than moderate residual mitral regurgitation (5% vs. 2.1% p < 0.01), repeat procedure rate (10% vs. 4.2% p < 0.01), improvement of (NYHA) class (90% vs. 95.7% p < 0.01), rest and provoked (LVOT) gradient < 50 mmHg (90% vs. 97.8% p < 0.01) were significantly reached. Conclusions: In patients with mildly symptomatic HOCM (NYHA II), earlier ASA may be performed as an effective and safe procedure in experienced centers. [ABSTRACT FROM AUTHOR]

Objective: This prospective study of pregnant patients, Surveillance To Prevent AV Block Likely to Occur Quickly (STOP BLOQ), addresses the impact of anti‐SSA/Ro titers and utility of ambulatory monitoring in the detection of fetal second‐degree atrioventricular block (AVB). Methods: Women with anti‐SSA/Ro autoantibodies by commercial testing were stratified into high and low anti–52‐kD and/or 60‐kD SSA/Ro titers applying at‐risk thresholds defined by previous evaluation of AVB pregnancies. The high‐titer group performed fetal heart rate and rhythm monitoring (FHRM) thrice daily and weekly/biweekly echocardiography from 17–26 weeks. Abnormal FHRM prompted urgent echocardiography to identify AVB. Results: Anti–52‐kD and/or 60‐kD SSA/Ro met thresholds for monitoring in 261 of 413 participants (63%); for those, AVB frequency was 3.8%. No cases occurred with low titers. The incidence of AVB increased with higher levels, reaching 7.7% for those in the top quartile for anti–60‐kD SSA/Ro, which increased to 27.3% in those with a previous child who had AVB. Based on levels from 15 participants with paired samples from both an AVB and a non‐AVB pregnancy, healthy pregnancies were not explained by decreased titers. FHRM was considered abnormal in 45 of 30,920 recordings, 10 confirmed AVB by urgent echocardiogram, 7 being second‐degree AVB, all <12 hours from normal FHRM and within another 0.75 to 4 hours to echocardiogram. The one participant with second/third‐degree and two participants with third‐degree AVB were diagnosed by urgent echocardiogram >17 to 72 hours from an FHRM. Surveillance echocardiograms detected no AVB when the preceding interval FHRM recordings were normal. Conclusion: High‐titer antibodies are associated with an increased incidence of AVB. Anti‐SSA/Ro titers remain stable over time and do not explain the discordant recurrence rates, suggesting that other factors are required. Fetal heart rate and rhythm (FHRM) with results confirmed by a pediatric cardiologist reliably detects conduction abnormalities, which may reduce the need for serial echocardiograms. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID‐19) has led to a worldwide pandemic that continues to transform but will not go away. Cardiovascular dysautonomia in postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection has led to persistent symptoms in a large number of patients. Here, we define the condition and its associated symptoms as well as potential mechanisms responsible. We provide a careful and complete overview of the topic addressing novel studies and a generalized approach to the management of individuals with this complex and potentially debilitating problem. We also discuss future research directions and the important knowledge gaps to be addressed in ongoing and planned studies. [ABSTRACT FROM AUTHOR]

Synchronous electrical cardioversion is a relatively common procedure in the emergency department (ED), often performed for unstable supraventricular tachycardia (SVT) or unstable ventricular tachycardia (VT). However, it is also used for stable cases resistant to drug therapy, which carries a risk of deterioration. In addition to the inherent risks linked with procedural sedation, there is a possibility of malignant arrhythmias or bradycardia, which could potentially result in cardiac arrest following this procedure. Here, we present a case of complete heart block unresponsive to transcutaneous pacing and positive inotropic and chronotropic drugs for 90 min, resulting in multiple cardiac arrests. The repositioning of the transcutaneous cardio-stimulation electrodes, one of them placed in the left latero-sternal position and the other at the level of the apex, led to immediate stabilization of the patient. The extubation of the patient was performed the following day, with full recovery and discharge within 7 days after the insertion of a permanent pacemaker. [ABSTRACT FROM AUTHOR]

Association of MOGAD with various autoimmune and paraneoplastic antibodies has been described in the literature. However, MOGAD with systemic manifestations is rarely encountered and requires a high index of suspicion for evaluation. Searching various databases, we identified 107 studies. After independently assessing the eligibility, finally, 29 studies were selected for review. A total of 1458 MOG patients were included in the study among whom systemic manifestations were present in 253 (17.3%) patients. SLE with ANA positivity was found in a total of 72 (28.4%) patients. Among them, anti‐dsDNA was positive in 10 (3.9%), anti‐smith in 3 (1.2%), anti‐SSA/SSB in 13 (5.1%), anti‐RNP in 3 (1.1%), anti‐Ro 52 in 1 (0.5%), and ENA in 1 (0.5%). APLA was positive in 10 (3.9%), ANCA in 10 (3.9%), RA in 31(12.9%) and thyroid antibody in 35 (13.8%) patients. Simultaneous CNS and PNS involvement was also seen in 21 (8.3%) patients. Systemic involvement is not an uncommon phenomenon in MOGAD and in future may add to the spectrum of the disease. [ABSTRACT FROM AUTHOR]

Bradyarrhythmias and conduction blocks are a common clinical finding and may be a physiologic reaction (for example in healthy, athletic persons) as well as a pathologic condition. Arbitrarily, bradyarrhythmias are defined as a heart rate below 60 beats per minute (bpm). These can be further categorized on the basis of the level of disturbances in the hierarchy of the normal cardiac conduction system. A total 100 consecutive high risk patients for having coronary artery disease requiring implantation of permanent pacemaker due to complete heart block or symptomatic sick sinus syndrome or conduction diseases were taken for study. This hospital based study was carried out to find the frequency of coronary artery disease in patients of chronic heart blocks who were candidates for permanent pacemaker implantation. 100 patients having chronic heart blocks who presented to emergency or OPD and admitted in cardiology ward of department of cardiology were taken for study. In all patients Coronary angiography was performed after PPM implantation who were at high risk for having coronary artery disease. In a population of 100 consecutive patients with newly implanted permanent pacemaker, who subsequently had coronary angiography due to high risk profile for coronary artery disease, the frequency of coronary involvement was 45% (total patients=100). Out of these 45 patients (N=45), 29 (64.44%) had obstructive coronary artery disease and 16 (35.56%) had non obstructive coronary artery disease. The most frequent symptom of this patient population is syncope/pre syncope (present in 100%) and angina and angina equivalent was present in 25% and 18% patients respectively. Since their main symptom at presentation is pre syncope/ syncope and their other cardiac symptoms are either ignored or not taken into consideration and their coronary artery disease remains undiagnosed, which can have detrimental effect on the morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia referred for ablation. Periprocedural conduction system damage was a primary concern during AVNRT ablation. This study aimed to assess the incidence of permanent atrioventricular (AV) block and the success rate associated with different types of catheters in slow pathway ablation. Method: A literature search was performed to identify studies that compared various techniques, including types of radiofrequency ablation (irrigated and nonirrigated) and different sizes of catheter tip cryoablation (4, 6, and 8‐mm), in terms of their outcomes related to permanent atrioventricular block and success rate. To assess and rank the treatments for the different outcomes, a random‐effects model of network meta‐analysis, along with p‐scores, was employed. Results: A total of 27 studies with 5110 patients were included in the analysis. Overall success rates ranged from 89.78% to 100%. Point estimation showed 4‐mm cryoablation exhibited an odds ratio of 0.649 (95%CI: 0.202–2.087) when compared to nonirrigated RFA. Similarly, 6‐mm cryoablation had an odds ratio of 0.944 (95%CI: 0.307–2.905), 8‐mm cryoablation had an odds ratio of 0.848 (95%CI: 0.089–8.107), and irrigated RFA had an odds ratio of 0.424 (95%CI: 0.058–3.121) compared to nonirrigated RFA. Conclusion: Our study found no significant difference in the incidence of permanent AV block between the types of catheters. The success rates were consistently high across all groups. These findings emphasize the potential of both RF ablation (irrigated and nonirrigated catheter) and cryoablation as viable options for the treatment of AVNRT, with similar safety and efficacy profile. [ABSTRACT FROM AUTHOR]

An 88‐year‐old Japanese woman underwent DDD pacemaker (MicroPort KORA 250 DR, V lead: VEGA R52) implantation for complete atrioventricular block. A 12‐lead electrocardiogram for a routine examination showed atrial pacing within the intrinsic P wave, followed by inhibition of ventricular pacing. Pacemaker interrogation revealed no abnormalities in the basic parameters; however, ventricular pacing was inhibited by far‐field sensing of intrinsic atrial waves before atrial events; type II far‐field P‐wave sensing. As a result, unusual atrial pacing occurred due to the pause suppression algorithm, which is the one of the functions that prevent atrial fibrillation development. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to respond to clinical question, can prolonged P-R interval predict clinical outcomes in non-ST elevation acute coronary syndrome patients? Methods: This descriptive-analytical study was conducted on cardiac patients. All of the non-ST elevation acute coronary syndrome (NSTEACS) including non-ST elevation myocardial infarction (NSTEMI) and unstable angina patients included in the study. Then they divided into two groups: prolonged P-R interval and normal P-R interval. The patients who had a history of digoxin and calcium channel blocker use, using antiarrhythmic drugs, known valvular or congenital heart disease and connective tissue, unreadable P-R interval and cardiac block were excluded. Data were collected using the questionnaire consisted demographic data and clinical outcomes and a follow-up part was completed by one of the researchers. Results: Finally, 248 patients completed the study. The results showed both of the two groups had significant differences in terms of the history of myocardial infarction (MI) (p = 0.018), the level of high-density lipoprotein (HDL) (p = 0.004), heart rate (p = 0.042), inverted T wave (p = 0.017), anterior ST- segment depression (p = 0.008), normal report of coronary angiography (CAG) (p = 0.003), three vessels disease (p = 0.043), left main lesion (p = 0.045) and SYNTAX score (p = 0.032) based on the CAG report. The results of six-month follow-up showed although, the frequency of ischemic stroke, coronary artery disease (CAD) and cardiovascular death were higher in prolonged P-R interval groups. The chi-square test showed this difference was statistically non-significant (p > 0.05). The multivariate logistic regression model revealed non-significant relationships between prolonged P-R interval and SYNTAX score, significant CAD, three-vessel disease, inverted T wave, anterior ST depression, heart rate and HDL. Conclusions: Based on the results of our study the six-month follow-up showed non-significant outcomes. Further studies are recommended to assess the long-term outcomes. [ABSTRACT FROM AUTHOR]

Defined as systemic hypotension caused by intense vasodilation due to the loss of systemic vascular resistance, vasoplegic syndrome (VS) is associated with elevated morbidity and mortality in humans. Although vasopressors such as norepinephrine and vasopressin are the first-choice drugs for VS treatment, several other drugs such as methylene blue (MB) can be used as adjuvant therapy including rescue therapy. To develop new pharmacological strategies to reduce the risk of VS, we investigated the effects of treatments with MB (2 mg/kg/IV), omeprazole (OME, 10 mg/kg/IV), and their combination in an animal model of cardiac ischemia–reperfusion (CIR). The ventricular arrhythmia (VA), atrioventricular block (AVB), and lethality (LET) incidence rates caused by CIR (evaluated via ECG) and serum levels of the cardiac lesion biomarkers creatine kinase–MB (CK-MB) and troponin I (TnI) in adult rats pretreated with saline solution 0.9% and submitted to CIR (SS + CIR group) were compared to those pretreated with MB (MB + CIR group), OME (OME + CIR group), or the MB + OME combination (MB + OME + CIR group). The AVB and LET incidence rates in the MB + CIR (100%), OME + CIR (100%), and MB + OME + CIR (100%) groups were significantly higher compared to the SS + CIR group (60%). The serum level of CK-MB in these groups were also significantly higher compared to the SS + CIR group, demonstrating that the treatments before CIR with MB, OME, and MB + OME produced similar effects in relation to cardiac function and the occurrence of lesions. These results demonstrate that the treatment of animals subjected to the CIR protocol with OME produced the same effects promoted by the treatment with MB, which may suggest the possibility of using OME alone or in combination with MB in medical clinics in treatment of VS. [ABSTRACT FROM AUTHOR]

Beta-aminocarbonyl compounds are important intermediates produced from Mannich condensation. In this research, benzaldehyde, para-hydroxy acetophenone or para-nitro acetophenone were reacted with a various of primary aromatic amines to give compounds (1-7) and (8-14), respectively. The chemical formulas of the synthesized compounds were confirmed by conducting some physical and spectroscopic measurements, such as, melting points, IR and H1-NMR spectrum. After testing the biological activity of some of the synthesized compounds (8,10,11,13) using Gram-positive (Streptococcus, and Staphylococcus aureus), Gram-negative (Klebsiella spp., and Escherichia coli) bacteria, as well as yeast strains, were chosen for this investigation (candidan albicans). Isolated bacteria were identified using standard methods of isolation and identification, including direct assays and culture on various media. Some theoretical tests have also been carried out such as SwissADME and cardioToxCSM prediction on all prepared compounds to predict their activity in terms of pharmacokinetic properties (ADME) and also predict their cardiotoxicity on some heart functions such as arrhythmia, cardiac failure, heart block, hERG toxicity, Hypertension (HT), and Myocardial Infarction (MI). [ABSTRACT FROM AUTHOR]

Citrus fruits are economically significant crops worldwide, as they contain various bioactive compounds that possess health-promoting properties. Carotenoids, as the most important component in citrus, exhibit notable pharmacological activities, such as antioxidation and anticancer, which make carotenoids valuable in the prevention and treatment of breast cancer. In this study, after treatment with carotenoid extracts from XiYou (XY) and ZaoHongQiCheng (ZH), we evaluated the cytotoxicity, apoptosis, antioxidant system, and oxidative stress induced by ROS overproduction and MMP damage in MDA-MB-231 cells. The analysis confirmed that cell proliferation was inhibited in a concentration-dependent manner, accompanied by G0/G1 arrest and cell apoptosis. XY and ZH promoted the accumulation of ROS, decreased MMP, increased malondialdehyde (MDA) levels, consumed glutathione (GSH), and reduced the activity of antioxidant enzymes (peroxidase (POD), catalase (CAT), glutathione reductase (GR), and superoxide dismutase (SOD)). Meanwhile, XY and ZH induced apoptosis through the mitochondrial pathway by significantly upregulated P53, BAX, caspase-3, caspase-7, and caspase-9 gene expression levels and downregulated Bcl-2. Carotenoid-rich extracts were found to cause oxidative stress by enhancing ROS production through their pro-oxidative potential, and the aggravation of oxidative processes promotes apoptosis in MDA-MB-231 cells. These results indicate that citrus carotenoids can be used as potential pro-oxidants and have the potential to be developed into products for the prevention or treatment of breast cancer. [ABSTRACT FROM AUTHOR]

The article focuses on the development and clinical success of CD40L antagonists for treating autoimmune diseases. Topics include the pivotal role of CD40L in immune responses and inflammation, the progress of CD40L antagonists in clinical trials for diseases such as systemic lupus erythematosus (SLE) and multiple sclerosis (MS), and the emergence of next-generation CD40L blockers with improved safety profiles and therapeutic efficacy.

The article discusses insights into human heart development and congenital heart defects, which are the most common birth defects. It highlights the importance of understanding disruptions in heart development to improve prenatal screening and inform heart repair approaches. Recent preprints by Sarah Teichmann and Sanjay Sinha provide valuable data on human fetal hearts, revealing new insights into cardiac cell types, gene regulatory networks, and cell lineage relationships. These datasets offer a significant resource for the cardiovascular community and may aid in understanding the origins of congenital heart defects. [Extracted from the article]

This article discusses a rare case of neonatal lupus erythematosus (NLE) with interstitial granulomatous dermatitis (IGD). NLE is an autoimmune disorder transmitted from the mother to the baby through maternal antibodies. The typical histopathological features of NLE are similar to subacute cutaneous lupus erythematosus, but immunohistochemical characteristics are rarely documented. The case presented in this report involved a 1-month-old male infant with erythematous plaques, and histopathological examination revealed vacuolar changes, mononuclear cell infiltration, and positive staining for CD68 and CD163. The article highlights the need for further research to explore the role of macrophages in IGD and the relationship between IGD and NLE. [Extracted from the article]

Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm. This latest article in a series on electrocardiogram (ECG) interpretation presents a case scenario and an ECG strip and takes readers step by step through analyzing the heart rhythm. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 12-year-old girl who experienced interaction between an epicardial and a new endocardial pacemaker during implantation, resulting in a complex electrocardiogram pattern that initially suggested device malfunction. It states that the interaction between the two pacemaker systems led to an intermittent fusion of pacing modes, which was resolved by adjusting the settings of the epicardial pacemaker and ultimately planning its removal.

This article discusses a case of pulmonary embolectomy following embolism during caval tumour thrombus nephrectomy for renal cell carcinoma. The patient, a 77-year-old man, underwent surgery to remove a locally advanced renal cancer with Level IV inferior vena cava (IVC) thrombus. During the surgery, the tumour thrombus was noted to be present in the right atrium, and it was later discovered that the thrombus had dislodged and migrated into the pulmonary circulation. The patient underwent pulmonary embolectomy and had a slow recovery with some complications. The article emphasizes the importance of early recognition and continuous monitoring in managing intraoperative tumour thrombus embolism. [Extracted from the article]

The article presents a case study of a 44-year-old female patient who underwent catheter ablation therapy for a slightly irregular supraventricular tachycardia (SVT). It also discusses the mechanisms of ventriculoatrial (VA) block during SVT, the differential diagnosis involving various types of tachycardias, and the role of upper common pathway (UCP) in AVNRT.

The article focuses on investigating a case of symptomatic loss of cardiac resynchronization therapy (CRT) in a patient with idiopathic dilated cardiomyopathy, despite initially favorable response. Topics include the mechanisms underlying CRT failure, potential adjustments to device programming to enhance heart failure management, and considerations for optimizing CRT efficacy to prevent recurrent decompensation episodes.

Natural cardiac glycosides have positive inotropic heart effects but at high, toxic doses they can cause life-threatening cardiac arrhythmias. Here we present the first Croatian case of a 16-year-old girl who attempted suicide by eating dried oleander leaves, which contain natural cardiac glycosides, and her treatment with a specific antidote. The girl presented with an oedema of the uvula indicating local toxicity, severe bradycardia, first-degree atrioventricular block, drowsiness, and vomiting. Having taken her medical history, we started treatment with atropine, intravenous infusion of dextrose-saline solution and gastroprotection, but it was not successful. Then we introduced digoxin-specific Fab antibody fragments and within two hours, the patient's sinus rhythm returned to normal. Cases of self-poisoning with this oleander are common in South-East Asia, because it is often used as a medicinal herb, and digoxin-specific Fab fragments have already been reported as effective antidote against oleander poisoning there. Our case has taught us that it is important to have this drug in the hospital pharmacy both for digitalis and oleander poisoning.

Permanent pacemaker implantation is a low-risk procedure. However, complications may occur at a rate of around 4–8%. We present a case where initial implantation resulted in complications that could have been avoided by meticulous assessment of lead position in different projections and early post-procedure X-ray that would have delineated other serious complications. We present a case where the right ventricular lead was placed in the coronary sinus, which resulted in the loss of pacing capture with further syncope after the pacemaker implant. This was apparent in the post-procedure electrocardiogram (ECG) with right bundle branch pacing and the lead was repositioned in the right ventricular apex the following day. Furthermore, the patient was discharged home without a chest X-ray (CXR), and she represented a week later with a haemo-pneumothorax and pericardial effusion. A chest drain was placed and was discharged after a slow recovery following several complications that could have been avoidable.

Background: Prenatal detection of critical congenital heart disease (CCHD) optimises perinatal decision-making and neonatal outcomes. The objective of this study was to determine the prenatal screening performance, care pathways and perinatal outcomes for prenatally and postnatally diagnosed cases of CCHD over a four-year period. Study design: This retrospective cohort study in a tertiary centre and its two affiliated secondary sites examined all cases of CCHD, including cases of pregnancy termination and in-utero fetal death, neonatal death and liveborn babies that underwent cardiac catheterization or surgery in the first six weeks of life. Prenatal and postnatal data were ascertained from the first trimester assessment for all patients diagnosed prenatally. Cases requiring intervention that were first identified in the postnatal period were included to determine prenatal detection rates. Follow-up for all cases of CCHD continued to one year of age. Results: In a consecutive cohort of 49,950 pregnancies in a 4-year period 01/2019 to 12/2022, a prenatal diagnosis of CCHD was made in 96 cases, yielding a prevalence of 1.9 per 1000 births. The prenatal detection for right duct-dependant heart pathology and congenital heart block was 100%, 85% for left duct-dependant pathology and 93% for transposition of the great arteries (TGA). In the prenatally diagnosed group, 37% of cases were complicated by extracardiac structural abnormalities, a genetic diagnosis or both. All cases of prenatal detection were identified in the context of routine anatomy screening rather than specialist Fetal Cardiac screening services. Almost half of all pregnancies complicated by CCHD did not undergo neonatal cardiac intervention, by virtue of parental choice determined either prenatally or after birth. An additional eight babies were diagnosed with CCHD in the neonatal period, such that the prenatal detection rate for CCHD was 92% (96/104, 95% CI = 84%-96%). Survival at 1-year for infants deemed suitable for CCHD surgery was 85%. Conclusion: In a large unselected population, optimal rates of prenatal detection of critical congenital heart disease can be achieved by a protocolised approach to mid-trimester fetal anatomy ultrasound, underpinned by a programme of sonographer education and training. The cardiac abnormalities most likely to evade prenatal detection are left-sided obstructive lesions. [ABSTRACT FROM AUTHOR]

Background: The fetuses of pregnant women affected by anti-Ro/anti-La antibodies are at risk of developing complete atrioventricular heart block (CAVB) and other potentially life-threatening cardiac affections. CAVB can develop in less than 24 h. Treatment with anti-inflammatory drugs and immunoglobulins (IVIG) can restore the normal rhythm if applied in the transition period. Routine weekly echocardiography, as often recommended, will rarely detect emergent AVB. The surveillance of these pregnancies is controversial. Home-monitoring using a hand-held Doppler is a promising new approach. Methods: To obtain an overview of the current practice in Germany, we developed a web-based survey sent by the DEGUM (German Society of Ultrasound in Medicine) to ultrasound specialists. With the intention to evaluate practicability of home-monitoring, we instructed at-risk pregnant women to use a hand-held Doppler in the vulnerable period between 18 and 26 weeks at our university center. Results: There are trends but no clear consensus on surveillance, prophylaxis, and treatment of anti-Ro/La positive pregnant between specialists in Germany. Currently most experts do not offer home-monitoring but have a positive attitude towards its prospective use. Intensified fetal monitoring using a hand-held Doppler is feasible for pregnant women at risk and does not lead to frequent and unnecessary contact with the center. Conclusion: Evidence-based guidelines are needed to optimize the care of anti-Ro/La-positive pregnant women. Individual risk stratification could help pregnancy care of women at risk and is welcmed by most experts. Hand-held doppler monitoring is accepted by patients and prenatal medicine specialists as an option for intensified monitoring and can be included in an algorithm for surveillance. [ABSTRACT FROM AUTHOR]

Background: Monkshood, a toxic plant containing a potent cardio- and neurotoxin called aconitine, can lead to a range of symptoms, including nausea, vomiting, dizziness, seizures, and cardiac arrhythmias. Mortality associated with this intoxication are due to ventricular tachyarrhythmias which are difficult to treat and often refractory in nature. Case presentation: We present a case of a 17-year-old female patient who presented to the emergency department after intentionally ingesting a monkshood plant and developed atrioventricular dissociation and frequent ventricular ectopy. The patient was successfully treated with activated charcoal, supportive care, and cardiac monitoring. Conclusion: This case highlights the importance of early recognition of aconitine poisoning and the need for prompt supportive care, cardiac rhythm monitoring, and preemptive antiarrhythmic treatment planning. [ABSTRACT FROM AUTHOR]

Oxidative stress, characterized by an imbalance between the production of reactive oxygen species (ROS) and the cellular anti-oxidant defense mechanisms, plays a critical role in the pathogenesis of various human diseases. Redox metabolism, comprising a network of enzymes and genes, serves as a crucial regulator of ROS levels and maintains cellular homeostasis. This review provides an overview of the most important human genes encoding for proteins involved in ROS generation, ROS detoxification, and production of reduced nicotinamide adenine dinucleotide phosphate (NADPH), and the genetic disorders that lead to dysregulation of these vital processes. Insights gained from studies on inherited monogenic metabolic diseases provide valuable basic understanding of redox metabolism and signaling, and they also help to unravel the underlying pathomechanisms that contribute to prevalent chronic disorders like cardiovascular disease, neurodegeneration, and cancer. [ABSTRACT FROM AUTHOR]

Introduction: Severe transitory episodes of bradycardia with subsequent syncope in children are common, and generally portend a benign prognosis. Rarely, patients may experience prolonged asystolic episodes secondary to significant sinus pauses (SP) or paroxysmal atrioventricular block (AVB). Cardioneuroablation (CNA) is a catheter‐based intervention, used to identify and ablate the epicardial ganglionated plexi (GP), which results in disruption of the vagal‐mediated parasympathetic input to the sinus and atrioventricular node. Objective: Describe the methodology and role of CNA for treatment of pediatric patients with functional AVB or SP. Methods: This is a single‐center, case series study. Patients with SP or AVB, 21 years of age or younger, who underwent CNA between 2015 and 2021 were included. CNA was performed via anatomically guided and high‐frequency stimulation methods. Results: Six patients were included. The median age was 18.9 years (range 12.3–20.9 years), 33% female. Two patients had prolonged SP, two had paroxysmal AVB, and two had both SP and AVB. Four patients had prior syncope. The median longest pause was 8.9 s (range 3.9–16.8) with 11 total documented pauses (range 2–231) during the 6 months pre‐CNA. Post‐CNA, the median longest pause was 1.3 s (range 0.8–2.2) with one documented SP after termination of atrial tachycardia at the 3‐month follow‐up. At 6 months, the median longest pause was 1.1 s (0.8–1.3) with 0 documented pauses. No patients had syncope post‐CNA. Conclusion: CNA may be an effective alternative to pacemaker implantation in pediatric patients with syncope or significant symptoms secondary to functional SP or AVB. [ABSTRACT FROM AUTHOR]

Background Lyme borreliosis (LB) of the heart is called Lyme carditis (LC), which often manifests with high-grade atrioventricular block (AVB) requiring pacemaker implantation. LC is treated with antibiotics, and most patients recover fully after treatment. The overall incidence of LC, and of LC as a cause of pacemaker implantation, has not previously been systematically studied. Methods This was a case-control study based on data from Swedish national registers. The study was divided into two parts; part 1 including all patients diagnosed with AVB between 2001 and 2018, and part 2 including all patients who had received a pacemaker due to AVB between 2010 and 2018. Patients diagnosed with LB 90 days before and 180 days after the AVB diagnosis were identified among the patients and compared to matched control groups generated from the general population. Results Of 81 063 patients with AVB, 102 were diagnosed with LB. In the control group, 27 were diagnosed with LB. The yearly incidence of LC was 0.056 per 100 000 adults and year. Of 25 241 patients who had received a pacemaker for AVB, 31 were diagnosed with LB. In the control group, 8 were diagnosed with LB. The yearly incidence of LC as a cause of pacemaker implantation was 0.033 per 100 000 adults and year. The estimated risk for patients with LC to receive a permanent pacemaker was 59%. Conclusions LC is a rare cause of AVB. Nevertheless, more than half of patients with LC receive a permanent pacemaker for a condition that is easily cured with antibiotics. [ABSTRACT FROM AUTHOR]

This document explores the potential of AI language models in the field of fetal medicine. It discusses how these models can assist specialists in assessing fetal anomalies, determining imaging protocols, and aiding in research and training. However, it also emphasizes the need for caution and recognition of limitations, as biases and inaccuracies can impact patient care. The document provides a comparison of different AI language models and their features, advantages, and disadvantages. It concludes by emphasizing the importance of a comprehensive evaluation process for AI language models in fetal medicine. [Extracted from the article]

Clinically significant bradycardia is an uncommon problem in children, but one that can cause significant morbidity and sometimes necessitates implantation of a pacemaker. The most common causes of bradycardia are complete heart block (CHB), which can be congenital or acquired, and sinus node dysfunction, which is rare in children with structurally normal hearts. Pacemaker is indicated as therapy for the majority of children with CHB, and while early mortality is lower in postnatally diagnosed CHB than in fetal CHB, it is still up to 16%. In young children, less invasive transvenous pacemaker systems can be technically challenging to place and carry a high risk of complications, often necessitating surgical epicardial pacemaker placement, which usually entails a median sternotomy. We report three cases of pediatric patients referred for pacemaker implantation for different types of bradycardia, treated at our institution with oral albuterol with therapeutic results that avoided the need for surgical pacemaker implantation at that time. [ABSTRACT FROM AUTHOR]

Background:Dengue infection is one of the common tropical infectious diseases. Clinicalmanifestations of cardiacinvolvement can vary widely, from an incidental finding to severe cardiac failure resulting in death. Aim:To assess the prevalence and clinical significance of major acute cardiovascular events after dengue infection. Methods:A comprehensive longitudinal investigation took place at a tertiaryhealthcare facilitylocated inRaigad (Maharashtra). The sampling techniqueinvolved the inclusion of 140 eligible dengue fever cases who were selected on a first come first serve basisafter the beginning of the study.A previous history of any cardiac disease, history of chronic kidney disease(CKD), pregnant women and children, as well as admission ECG suggestive of old ischemicchanges, and use of medications affecting heart rate were excluded from the study. Results: Prevalence of cardiac inflammation in dengue fever cases were 26.4%. The elevatedhs-Troponin-T (pg/ml) in 25.0% cases and elevated CK-MB (U/L) in 23.6% cases.1st-degree heart block in 10.8%,2nd-degree heart block in 2.7%, complete heart block in 2.7%, atrial fibrillation in 10.8%, ST elevation in 5.4%, ventricular tachycardia in 2.7% and sinus tachycardi a in 13.5%. 37.8% cases found EF <40.0% echocardiography, 24.3% cases EF 40-50% and regional wall motion abnormality (RWMA) in 51.4% cases. Conclusion: Our study revealed that patients withnormal echo, ECG and serum levels of markers of cardiac injury are atlow risk for mortality and hence may need less monitoring or therapeutic intervention. Our study elucidates various significantfindings that advocate for tailored interventions, heightened awareness of cardiac involvement, andstrategic use of diagnostic tools. [ABSTRACT FROM AUTHOR]

Cardiac pacemaker implantation after orthotopic heart transplantation declined dramatically after development of the bicaval anastomosis technique. However, much less is known about the rate, indications, and predictors of device implantation procedures with the current surgical technique. The purpose of this study was to evaluate the indications, patient characteristics, incidence, and survival related to cardiac implantable electronic device (CIED) implantation after heart transplantation. This was a single-center study of 399 consecutive adult recipients of orthotopic heart transplants with bicaval anastomosis from 1991 to 2017. The primary end point was freedom from pacemaker or implantable cardioverter-defibrillator (ICD) implantation, and the secondary end point was all-cause mortality. At the time of transplantation, the mean age of recipients was 50 ± 12 years and that of donors 31 ± 12 years. CIEDs were implanted in 8% of recipients (n = 31): 11 pacemakers (35%) for sinus node dysfunction, 17 (55%) for high-grade heart block, and 3 ICDs (10%) for the primary prevention of sudden cardiac death. Early CIED implantation (<30 days) was rare and absent for sinus node dysfunction. The risk for CIED implantation increased progressively during follow-up (0–30 years; median 11 years), with low-, moderate-, and high-risk periods between 0 and 10, between 10 and 20, and between 20 and 30 years, respectively. Recipients receiving CIEDs survived longer after transplantation (21 years vs 13 years; P <.01). Recipients receiving pacemakers for heart block were more likely to receive older donor hearts at the time of transplantation. The risk of pacemaker implantation increases progressively, while ICD implantation is rare. Donor age is the predominant risk factor for subsequent heart block. Early sinus node dysfunction requiring permanent pacing is rare. [ABSTRACT FROM AUTHOR]