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Background: Pulsed‐field ablation (PFA) is a cutting‐edge technique that employs non‐thermal energy to cause cell death by inducing irreversible electroporation of cell membranes. This systematic review evaluates the PFA effectiveness as a potential alternative to radiofrequency and cryo‐ablation for treating ventricular tachycardia. Methods: PubMed, Embase, Scopus, and Web of Science were systematically searched using keywords related to ventricular tachycardia and pulsed‐field ablation. Eligible Studies evaluating this therapeutic approach for ventricular tachycardia were included in the final analysis. Results: We included six studies (five case reports and one case series) in our systematic review. Eight (88.8%) of procedures were successful with 100% long‐term efficacy. No procedural complications or ventricular tachycardia (VT) recurrence were observed in the cases. Conclusion: The absence of complications, high effectiveness, and long‐term success rate make PFAs a good VT treatment option. However, PFA safety and efficacy studies for VT treatment are scarce. Thus, larger investigations on this topic are urgently needed. [ABSTRACT FROM AUTHOR]

Background and Aims: Paravalvular leak (PVL) is a serious complication of prosthetic valve replacement. Both surgical and percutaneous closure techniques are used for PVL closure, but optimal strategies and comparative outcomes are uncertain. This study aimed to compare the efficacy and safety of percutaneous versus surgical PVL closure by analyzing changes in leak severity, functional status, echocardiographic parameters, and clinical outcomes. Methods: A total of 72 patients were included in this retrospective cross‐sectional single‐center study comparing percutaneous (n = 25) and surgical (n = 47) PVL closure from 2015 to 2022. Demographics, medical history, echocardiograms, laboratory data, complications, and mortality data were extracted from the records. Changes in leak severity, NYHA class, echocardiographic parameters, and clinical outcomes were compared between the percutaneous and surgical groups. Results: Both percutaneous and surgical PVL closure significantly reduced leak severity and improved NYHA class (both p < 0.01), with no difference between the quantity of changes in each group. The 30‐day mortality was 4% after percutaneous and 6.4% after surgical closure (p = 0.65). At 90 days, mortality was 24% percutaneous versus 17% surgical (p = 0.48). The length of stay in the hospital and post‐procedural decrease in hemoglobin were considerably lower in the percutaneous group. The rate of complication rates was similar between the groups. Echocardiographic changes were also comparable. Conclusion: Percutaneous and surgical PVL closure had similar efficacy in reducing leaks and improving symptoms, with no significant difference in early outcomes. Both options should be considered viable for PVL repair after heart team evaluation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Atrial fibrillation (AF) augments the risk of stroke by 4-5 times. Vitamin D is pivotal in numerous metabolic pathways. A handful of studies have explored the correlation between vitamin D deficiency (VDD) and AF outcomes. Hence, the authors sought to assess the relationship between VDD and AF outcomes. METHODS: From December 2021 to February 2023, 190 patients with AF were incorporated into the authors’ study. Given the seasonal fluctuation of vitamin D levels, these levels were examined from the start of December until the end of March. RESULTS: The final analysis comprised 190 patients (55.8% male) with an average age of 46.22±15.03. Vitamin D deficiency, insufficiency, and sufficiency were noted in 77 (40.5%), 46 (24.2%), and 67 (35.3%) patients, respectively. Fatigue and syncope were significantly more prevalent in the VDD group than in other groups. Three-vessel disease was more frequent in the VDD group (p-value=0.04). Mortality was more prevalent in patients with VDD (6.31%) compared to the VDI (2.10%) and VDS (0.05%) groups (p = 0.03). Successful cardioversion was significantly more prevalent in the VDS group (p = 0.03). CONCLUSION: A sufficient level of vitamin D was linked with a better response to cardioversion. However, low vitamin D levels are correlated with higher mortality in AF patients. [ABSTRACT FROM AUTHOR]

Background: Breast cancer, as the most common malignancy among females, is a great concern for global health. Early diagnosis and advanced chemotherapy regimens have improved patients' survival, while increasing morbidities caused by chemotherapy in the long run. Chemotherapy regimens have caused a decrease in myocardial functional, which can be detected by echocardiography. Objectives: The present study aimed to assess the decline curve in the left ventricular function parameters following chemotherapy and to compare the results among patients based on their Human Epidermal Growth Factor Receptor-2 (HER2) status. Methods: This study was conducted on 427 consecutive female patients with breast cancer referred to the Cardio-Oncology Department of Rajaie Cardiovascular, Medical, and Research Center for pre-chemotherapy assessment between January 2019 and December 2020. The patients were divided into two groups based on the HER2 status. All the patients had at least one baseline (pre-chemotherapy) transthoracic echocardiography and were scheduled for four follow-up sessions: early post-anthracycline therapy and 3, 6, and 12 months following chemotherapy. Each echocardiography examination included the assessment of 2D Left Ventricular Ejection Fraction (LVEF), 3D LVEF, Global Longitudinal Strain (GLS), and Global Circumferential Strain (GCS). Linear mixed-effects models were utilized and the results were compared within and between the study groups. The R Project for Statistical Computing was used for data analysis. Results: The results revealed significant changes in the means of 2D LVEF, 3D LVEF, GLS, and GCS during the 12 months of follow-up (t = -27.04, -37.15, -33.3, and -21.5, respectively; P < 0.001). Besides, the decline was more prominent in the HER2 positive patients (t = -19.86, -15.35, -10.8, and -9.6, respectively; P < 0.001). Conclusions: The study results revealed a significant decline in the LV function parameters including 2D LVEF, 3D LVEF, GLS, and GCS following chemotherapy with anthracycline. This decline was more prominent in the HER2 positive patients who underwent Herceptin treatment. These results showed that the use of cardioprotective agents might lower the rate of decline in LV function parameters. [ABSTRACT FROM AUTHOR]

Introduction: In January 2020, a new coronavirus was identified as the source of a newly developing type of pneumonia (COVID-19) in China. The number of infected people has been rising swiftly throughout the world since then and it has been reported to affect multiple systems apart from causing usual atypical pneumonia, one of which being the cardiovascular system. The underlying mechanism leading to cardiac injury has been hypothesized to be linked to a cytokine storm with unbalanced response to T-cell subtypes or secondary hemophagocytic lympho-histiocytosis, direct cardiac injury through viral myocarditis or cardiomyopathy through the ACE2 receptor, oxygen supply/demand imbalance with or without coronary artery disease, hypoxemia, and positive pressure ventilation leading to increased right ventricular afterload due to respiratory acidosis. Case Presentation: A 49-year-old female with a non-notable medical history presented to the emergency department with the chief complaint of dyspnea, fever and chills, severe dry coughs, and diarrhea. COVID-19 was confirmed by chest Computed Tomography (CT) scan and Real-Time Polymerase Chain Reaction (RT-PCR). Due to high troponin levels, echocardiography was done, indicating that the patient had a reduced left ventricular ejection fraction with multiple large Left Ventricular (LV) clots, but she had no lesions in coronary angiography. Conclusions: The pathological mechanism by which SARS-COV-2 causes viral myocarditis is still uncertain. However, it may result in cardiac injury via multiple mechanisms. COVID-19 may also predispose the body to thromboembolism in different ways. The current data suggested the existence of a hyper-coagulability state in patients with COVID-19 and endotheliitis could explain the reason why these patients seem more prone to venous and arterial thrombosis. However, further studies are needed to determine the other causes of the cardiovascular complications of COVID19. [ABSTRACT FROM AUTHOR]

Background: Recent advances in the early detection and management of breast cancer have conferred longer patient survival. Breast irradiation-induced cardiotoxicity has been associated with a decrease in the echocardiographic markers of myocardial function and an increase in cardiac mortality. Objectives: This study aimed to determine the cardiac effects of radiotherapy on patients with breast cancer based on cancer laterality. Methods: The present study assessed the records of 72 consecutive women with breast cancer who were referred to the Cardio-Oncology Department of Rajaie Cardiovascular Medical and Research Center between April 2017 and September 2020 and had baseline echocardiographic examinations and at least one follow-up echocardiographic examination within the first year of the initial examination. The patients were divided into left- and right-sided breast cancer groups to compare the results. The two groups were compared regarding the means of 2D Left Ventricular Ejection Fraction (LVEF), 3D LVEF, Global Longitudinal Strain (GLS), and Global Circumferential Strain (GCS) before and after radiotherapy. Analysis of Covariance (one-way ANCOVA) was used to compare the results (α = 0.05). All analyses were carried out using the SPSS software, version 26. Results: The changes in the means of 2D-LVEF, 3D-LVEF, GLS, and GCS were statistically significant among all the patients irrespective of cancer laterality (P < 0.001, P < 0.001, P = 0.001, and P = 0.002, respectively). However, no significant differences were observed between the left- and right-sided breast cancer groups vis-à-vis the means of 2D-LVEF, 3D-LVEF, GLS, and GCS (P = 0.44, P = 0.65, P = 0.21, and P = 0.25, respectively). Conclusions: The study results showed significant declines in the means of 2D-LVEF, 3D-LVEF, GLS, and GCS following radiotherapy. The patients with right-sided breast cancer exhibited a significant decrease in all the mentioned measures, whereas those with left-sided breast cancer showed no significant decline in post-radiotherapy speckletracking parameters. In addition, comparison of the patients with left- and right-sided breast cancers revealed no significant difference in the echocardiographic parameters of cardiotoxicity regarding cancer laterality. [ABSTRACT FROM AUTHOR]

Introduction: Decreased left atrial appendage emptying velocity (LAAV) is a marker for thrombus formation. This study evaluates the association between LAAV and inflammatory indices in non-valvular atrial fibrillation (AF) patients., Methods: The study population was 1428 patients with AF, 875 of whom enrolled. Based on the LAAV, patients were divided into three groups of 262 patients with a velocity of <25 cm/s, 360 patients with a velocity of 25 to 55 cm/s, and 253 patients with a velocity of >55 cm/s to assess and compare in terms of inflammatory indices, including the platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, systemic immune inflammation index, neutrophil - to - platelet ratio and white blood cell-to-platelet ratio (WPR)., Results: There was no statistical difference in the level of inflammatory indices between the three groups, and none of them were related to LAAV ( p  > .05) except WPR with a weak negative correlation ( p  = 0.01, r  = -0.10). Patients with lower LAAV were found to have a higher age ( p  = 0.001), decreased left ventricular ejection fraction ( p  = 0.001) and greater left atrial volume index ( p  = 0.001)., Conclusion: This study did not show any association between inflammatory indices and LAAV in non-valvular AF patients except for the WPR.

Background: This study aims to evaluate the prognostic value of the inflammatory indices i.e. Platelet Lymphocyte Ratio (PLR), Neutrophil Lymphocyte Ratio (NLR), and Systemic Immune Inflammation Index (SII) as potential predictors of Major Adverse Cardiovascular Event (MACE) in patients undergoing Primary Percutaneous Coronary Intervention (PPCI) on Saphenous Vein Graft (SVG) with a history of Coronary Artery Bypass Graft (CABG)., Methods: This retrospective study evaluated 74 patients who underwent PPCI on SVG at a tertiary centre between 2015-2023. Patients were divided based on experiencing MACE within one year. Baseline characteristics and inflammatory markers were compared between groups. Logistic regression identified predictors of MACE., Results: Of these 78, 74 completed the one-year follow-up and were included in the analysis. MACE occurred in 24 patients. We divided patients into two groups based on the occurrence of MACE. The MACE group had a significantly higher pre-procedural PLR compared to others (Mean difference [95%CI]: 22.24 [1.39, 42.23], p-value: 0.0346), while pre-procedural NLR, and SII, and post-procedural PLR, NLR, and SII were comparable between groups. Left Ventricular Ejection Fraction (LVEF) and pre-procedural PLR were predictors of one-year MACE; however, with low odds ratios (Odds Ratio [95%CI]: 0.91 [0.86, 0.96], 1.02 [1.00, 1.03], respectively). Only LVEF was an independent predictor of MACE. LVEF yielded a better discriminatory power than pre-procedural PLR. Pre-procedural PLR > 104.18 yielded a 70% sensitivity at 54% specificity for one-year MACE., Conclusion: Pre-procedural PLR and LVEF might be a predictor of one-year MACE following PPCI on SVG in post-CABG patients.