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Several clinical, electrocardiographic (ECG) and electrophysiological markers have been proposed to provide optimal risk stratification in patients with Brugada syndrome (BrS). Of the different markers, only a spontaneous type 1 ECG pattern has clearly shown a sufficiently high predictive value. This review article highlights specific ECG markers based on depolarization and/or repolarization that have been associated with an increased risk of arrhythmic events in patients with BrS. Keywords: Brugada syndrome, Electrocardiogram, Sudden cardiac death

BackgroundVentilator-associated pneumonia (VAP), one of the most common hospital-acquired infections, has a high mortality rate.ObjectivesTo evaluate the incidence of VAP in a multidisciplinary intensive care unit and to examine the effects of the implementation of ventilator bundles and staff education on its incidence.MethodsA 24-month-long before/after study was conducted, divided into baseline, intervention, and postintervention periods. VAP incidence and rate, the microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit were recorded and compared between the periods.ResultsOf 1097 patients evaluated, 362 met the inclusion criteria. The baseline VAP rate was 21.6 per 1000 ventilator days. During the postintervention period, it decreased to 11.6 per 1000 ventilator days (P = .01). Length of stay in the intensive care unit decreased from 36 to 27 days (P = .04), and duration of mechanical ventilation decreased from 26 to 21 days (P = .06).ConclusionsVAP incidence was high in a general intensive care unit in a Greek hospital. However, implementation of a ventilator bundle and staff education has decreased both VAP incidence and length of stay in the unit.

AIMS Atrial fibrosis is associated with the pathogenesis and progression of atrial fibrillation (AF). We sought to evaluate the extent of left atrial (LA) scarring in patients with paroxysmal AF (PAF) undergoing catheter ablation using a new impedance-based algorithm. METHODS We prospectively enrolled 73 consecutive patients (43 males, 58 years) with PAF who underwent pulmonary vein antral isolation. We first performed high-density bipolar voltage mapping during sinus rhythm using Tissue Proximity Indicator (TPI), one of the features of the ConfiDense mapping module integrated in the electroanatomic mapping system. A dense LA shell was created initially without TPI (mean points 2,411) and subsequently activating TPI (mean points 1,167). Each point was classified according to the peak-to-peak bipolar voltage electrogram based on two criteria (criterion A: healthy >0.8 mV, border zone: 0.4-0.8 mV, scarred: 0.5 mV, border zone: 0.25-0.5 mV, scarred

Objectives Carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels have been associated with a poor outcome in patients with various pathological conditions including cardiovascular diseases. Our aim was to retrospectively assess the prognostic value of arterial COHb and MetHb in patients with acute pulmonary embolism (PE). Methods We conducted a retrospective study of 156 patients admitted in a pulmonary clinic due to acute PE. Measured variables during emergency department evaluation that were retrospectively analyzed included the ratio of the partial pressure of oxygen in arterial blood to the fraction of oxygen in inspired gas, Acute Physiology and Chronic Health Evaluation II score, risk stratification indices, and arterial blood gases. The association between arterial COHb and MetHb levels and disease severity or mortality was evaluated using bivariate tests and logistic regression analysis. Results Arterial COHb and MetHb levels correlated with Acute Physiology and Chronic Health Evaluation II and pulmonary severity index scores. Furthermore, arterial COHb and MetHb levels were associated with troponin T and N-terminal pro–B-type natriuretic peptide levels. In univariate logistic regression analysis, COHb and MetHb levels were both significantly associated with an increased risk of death. However, in multivariate analysis, only COHb remained significant as an independent predictor of in-hospital mortality. Conclusion Our preliminary data suggest that arterial COHb and MetHb levels reflect the severity of acute PE, whereas COHb levels are independent predictors of in hospital death in patients in this clinical setting. These findings require further prospective validation.

cases analyzed in our study, pulmonary embolism was considered as idiopathic or the result of trauma, fracture, or other form of immobilization of the patient. Clearly, the possibility of occult hematologic disease cannot be completely ruled out, especially in cases considered as idiopathic. Nevertheless, the analysis of the data coming up from patients' medical record, clinical examination, or laboratory tests does not support such a possibility. On the other hand, second-hand smoking could represent an additional limitation of our retrospective study, although it is difficult to estimate the extent of this limitation. We should also take into account the difficulty in assessing passive smokers' exposure to environmental tobacco smoke. Althoughmedical history taking in our hospital checks for exposure to cigarette smoking, it does not comprise a standard questionnaire for the semiquantitative evaluation of passive smoking. Two patients who spontaneously reported a very high exposure to passive smoking were classified as smokers and were excluded from the study. Ideally, the quantification of exposure to passive smoking should be based on the information reported by parents and verified by themeasurement of cotinine levels in saliva or urine to support their statements [3]. Of course, this was impossible in our study due to its retrospective nature. Furthermore, although passive smoking has been repeatedly reported to acutely increase COHb levels, most of thesemeasurements have been carried out during participants' exposure to second-hand smoking or shortly after this. Moreover, this effect appears to be dose dependent. Thus, lower levels or shorter durations of smoke exposure fail to significantly increase COHb levels [4]. Generally, exogenously delivered CO presents a half-life of 5 to 6 hours without supplemental oxygen administration [5]. Therefore, it is not surprising that COHb had poor discriminating ability for passive smoking inwhen evaluated later after the exposure during the preoperative process [6,7]. We consider this clinical setting to present more similarities with our study compared with other studies involving the acute effects of environmental tobacco smoke exposure under experimental conditions. Yours sincerely