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Diabetes mellitus is a metabolic disorder characterized by an increase in blood sugar levels. The mechanism of arrhythmias in patients with diabetes mellitus is complex and unique. This is an independent factor in the occurrence of arrhythmias through several slightly different mechanisms in non-diabetics. Hyperglycemia, hypoglycemia, remodeling, autonomic neuropathic dysfunction, fibrosis, and oxidative changes, and metabolic stress play an important role in the occurrence of arrhythmias in diabetes. This narrative review was at least to describe the mechanism of arrhythmia in diabetes mellitus.

Objective : To report the diagnosis and management of congenital total AV block on VSD and PDA in pregnancy. Method : A case report Case : A 37-year-old multiparous woman G4P3A0H2 24- 25 weeks of preterm pregnancy with fetal bradycardia, VSD, PDA with ultrasonography and CTG results was FHR 70 bpm. At 37- 38 weeks of pregnancy, termination of pregnancy was performed by cesarean delivery with preparation for complication of fetal AV block. A male baby was born with weight 2600 gram and APGAR score of 8/9. Immediate echocardiography result was situs solitus, VSD PM LR shunt, PDA LR shunt, good left ventricular function, left aortic arch and EF 74%. ECG result was sinus bradycardia, total AV block with junctional escape rhythm. Sternotomy and PPM implantation was performed by cardiothoracic surgeon three hours after the baby was born. Post PPM implantation, ECG results was HR 165 bpm and chest X- rays interpretation was cardiomegaly with plethora. Mother and baby came home in good condition on the 6 th day of treatment. On the next baby’s control at 4.5 months obtained a weight of 5.4 kg with the echocardiography results was solitus, VSD PM L a R shunt, VSD muscular multiple 3 pieces L a R shunt, PDA L a R shunt, good right and left ventricular function, and left arch. The child got captopril 2x1.5 mg and planned for a 6-month repeat echocardiography. Conclusion : Congenital of total AV block on VSD and PDA is confirmed by prenatal diagnosis and preparation for comprehensive multidisciplinary management. Keywords: congenital total AV block, fetal bradycardia, fetal echocardiography, PPM, ultrasound

Atrial fibrillation (AF) is the most commonly encountered cardiac dysrhythmia, and AF patients are five times more likely to have a risk of stroke. Although the effects of stroke on patients are quite severe, lately it has been recognized that AF is associated with the incidence of cognitive impairment and dementia.This study aims to analyze and determine the differences in two isoforms of amyloid beta (Aββ40 and 42) and malondialdehyde (MDA) serum levels in AF patients who experience and who do not experience cognitive impairment.An observational study with case-control design was carried out on 63 people with atrial fibrillation, consisting of 38 people with cognitive impairment and 25 people without cognitive impairment. Examination of MDA and the Aβ40 and Aβ42 levels was carried out by ELISA. The difference level of each variable in the two groups was tested by the Mann-Whitney and χLower mean levels of Aβ42 and higher mean levels of MDA were found in the group with cognitive impairment rather than in the group without cognitive impairment. Lower mean levels of Aβ40 were found in the group with cognitive impairment rather than in the group without cognitive impairment but this difference was not statistically significant.Significantly lower levels of Aβ42 and higher levels of MDA were found in the AF patients with cognitive impairment rather than in the AF patients without cognitive impairment.

Early repolarization (ER) pattern is marked with J-point elevation, slurring or notching the terminal portion of the QRS and ST segment elevation has been considered benign over the last few decades. However, some reports now suggest a link between early repolarization and increased risk of death due to arrhythmias and idiopathic ventricular fibrillation (VF), known as ER syndrome. Implantable cardioverter-defibrillators implantation and drug isoproterenol are the suggested therapy in patients with ER syndrome. In contrast, patients without symptoms of the syndrome ER are common and have a better prognosis. Risk stratification in asymptomatic patients in the ER remains a gray area. There are still many unanswered questions, so studies exploring the underlying mechanisms of ER continues to be developed.

Background : Treadmill exercise test remains an important method and often used in the initial evaluation of patients with chest pain and can be a filter for more expensive invasive diagnostic. Increased QT dispersion (QTD) occurs because of the heterogeneity of ventricular repolarization because transient ischaemia during a treadmill stress test can be a marker of coronary artery disease (CAD) and can improve the accuracy of exercise tests to diagnose CAD, but this parameter is still controversial. Method : This is an analytic observational approach with a cross sectional study. Data was taken retrospectively at the Heart Center Installation at RSUP Dr. M. Djamil Padang, from March to April 2019, stable angina pectoris patient with a positive treadmill stress test who underwent coronary angiography as the subject. Bivariate analysis was performed on changes in QTcD (∆QTcD) and QTdR (∆QTdR) variables on the significance of coronary lesions by the chi-square method, after which a diagnostic test was based on receiver operating curve (ROC) analysis. Study Result : There were 122 subjects and found that older age, male and smoking were more common in groups with significant coronary lesions. Cut off point for ∆QTcD is ≥13 ms with a sensitivity of 87,1% and specificity 85,2% and AUC 95,1%, while ∆QTdR ≥5.5% with sensitivity 85,7% and specificity 81,9% and AUC 90,5% are related to significancy of coronary lesion. Obtained subjects with significant lesions generally had a value of ∆QTcD ≥ 13 ms (p

Aritmia ventrikel setelah IKP awalnya diindikasikan sebagai reperfusi yang sukses. Namun, beberapa penelitian menyebutkan bahwa aritmia ini diakibatkan oleh iskemia yang sedang berlangsung. Aritmia yang sering terjadi adalah kontraksi ventrikel premature sustained atau nonsustained takikardi ventrikel, accelerated idioventricular tachycardia, fibrilasi atrium, dan fibrilasi ventrikel. Gangguan irama dihubungkan dengan oklusi koroner didefinisikan sebagai aritmia iskemik, sedangkan aritmia terjadi akibat peningkatan perfusi miokard yang disebut aritmia reperfusi. Accelerated idioventricular tachycardiabisa menjadi penanda dari reperfusi awal dan patensi arteri berkelanjutan. Penatalaksanaan aritmia ventrikel pasca intervensi koroner perkutan meliputi penggunaan obat anti aritmia, overdrive pacing, ablasi radiofrekuensi, dan ICD. Kata kunci: aritmia ventrikel, IKP, obat anti aritmia, overdrive pacing, ablasi radiofrekuensi, dan ICD

Latar Belakang: Gagal Jantung dibagi menjadi 3 kelompok yaitu gagal jantung fraksi ejeksi menurun (HfrEF 4. Sistem skoring EKG memiliki sensitivitas 71,4% dan spesifisitas 88,6% dengan AUC 87,9% Kesimpulan : Sistem skoring EKG pada penelitian ini dapat digunakan sebagai pedoman awal dalam menentukan fraksi ejeksi ventrikel kiri pada pasien GJK Kata kunci : elektrokardiografi, gagal jantung kronik, fraksi ejeksi ventrikel kiri Background: Heart failure (HF) are divided into HF reduced ejection fraction (HFrEF4. It has sensitivity 71,4%, specificity 88,6% with AUC 87,9%. Conclusion: Electrocardiography scoring system in this study can be used as an initial tools to determining LVEF in patients with CHF. Keywords: electrocardiography, chronic heart failure, left ventricular ejection fraction

Background: Data on the optimal therapeutic international normalized ratio (INR) for non-valvular and valvular atrial fibrillation (AF) in Indonesia is currently unavailable. Therefore, we designed the Indonesian Registry on Atrial Fibrillation (OneAF) registry in order to seek a safe and beneficial range of INR in Indonesian patients with non-valvular and valvular AF. Methods/design: The OneAF registry is a nationwide collaboration of the Indonesian Heart Rhythm Society (InaHRS) enrolling all hospitals with cardiac electrophysiologists in Indonesia. It is a prospective, multicentre, nationwide, observational study aiming to recruit non-valvular and valvular AF patients in Indonesia. The registry was started in January 2020 with a planned 2 years of recruitment. There are 2 respondents for this registry: non-cohort and cohort respondents. Non-cohort registry respondents are AF patients at hospitals who fulfill inclusion and exclusion criteria but did not consent for a 24 month follow up. Whereas patients who consented for a 24 month follow up were included as cohort registry respondents. Key data collected includes basic sociodemographic information, symptoms and signs, medical history, results of physical examination and laboratory test, details of diagnostics and treatment measures and events. Results: Currently, a total of 1568 respondents have been enrolled in the non-cohort registry, including 1065 respondents with non-valvular AF (67.8%) and 503 respondents with valvular AF (32.2%). We believe that the OneAF registry will provide insight into the regional variability of anticoagulant treatment for AF, the implementation of rhythm/rate control approaches, and the clinical outcomes concerning cardiocerebrovascular events. Trial registration: Registered at clinicaltrials.gov (NCT04222868).

Salah satu permasalahan neurologi yang ditemukan pada penderita fibrilasi atrium (FA) adalah gangguan kognitif. Silent Brain Infarction (SBI) diyakini menjadi salah satu mekanisme utama yang mendasari terjadinya gangguan ini. Sudah dilaporkan juga bahwa hipoksia serebri akan menimbulkan peningkatan kadar glutamat ektraseluler sehingga bersifat neurotoksisitas dan menimbulkan kematian sel. Tujuan: Menganalisis kadar serum glutamat pada pasien Fibrilasi Atrial (FA) dengan gangguan kognitif. Metode: Penelitian dengan disain potong lintang dilakukan di Poliklinik Kardiologi dan Neurologi RS DR M Djamil Padang serta Laboratorium Biomed Fakultas Kedokteran Universitas Andalas. Pemeriksaan kadar glutamat serum dilakukan dengan metode Elisa dan pemeriksaan fungsi kognitif dengan test neuropsikologi Montreal Cognitive Assestment versi Indonesia (MoCA-Ina). Perbedaan kadar glutamat serum pada kelompok FA dengan gangguan kognitif dan kelompok FA tanpa gangguan kognitif diuji dengan t test bila distribusi data normal dan test Mann Whitney bila data tidak terdistribusi normal. Hubungan antara kadar glutamat dengan kejadian gangguan kognitif dilakukan dengan uji Chi-square, setelah dicari dulu nilai cut off point untuk kadar glutamat serum. Uji dikatakan bermakna bila nilai p < 0,05. Hasil: Kadar glutamat serum kelompok FA dengan ganggan kognitif lebih tinggi dari kelompok FA tanpa gangguan kognitif. Pasien FA yang mempunyai kadar glutamat tinggi ( > 29,5µMol/L) beresiko mengalami gangguan kognitif 10,2 kali lebih tinggi dari penderita yang mempunyai kadar glutamat normal (< 29,5 µMol). Simpulan: Ada hubungan antara kadar glutamat serum dengan terjadinya gangguan kognitif pada penderita FA.Kata kunci: fibrilasi atrial, fungsi kognitif, glutamat, silent brain infarction

Hipertensi merupakan massalah kesehatan global dan faktor risiko utama morbiditas dan mortalitas penyakit kardiovaskular (PKV). Pemeriksaan baku emas untuk mendiagnosis HVK adalah dengan menggunakan ekokardiografi dan magnetic resonance imaging (MRI). Tidak semua fasilitas kesehatan mampu melakukan pemeriksaan ini dan mahal. Elektrokardiografi (EKG) merupakan pemeriksaan yang dimiliki hampir di semua fasilitas kesehatan. Pemeriksaan ini murah dan mudah untuk digunakan. tahun 2009, American Heart Association/American College Cardiology Fondation/Heart Rhythm Study (AHA/ACCF/HRS) mengeluarkan daftar 36 kriteria EKG untuk diagnosis HVK namun sensitivitasnya relative rendah. Tinjauan pustaka ini bertujuan untuk menjelaskan peranan EKG untuk memprediksi hipertrofi ventrikel kiri khususnya pada hipertensi.

Background. Right Ventricular Outflow Tract (RVOT) tachycardia is frequently found in clinical practice. Despite of its good prognosis no need it usually affects the reproductive age (20-40 years) and can be very symptomatic. Radio frequency ablation (RFA) is a recommended therapeutic option of RVOT tachycardia. The aim of this study is to evaluate longterm resultsof RFA in National Cardiovasxular Center Harapan Kita. Method. A retrospective cohort study conducted to subjects with RVOT tachycardia who underwent RFA during period of 2005-2011. Clinical characteristics are revealed from medical record and electrophysiology characteristics are revealed from electrophysiology recording system (PruckaTMandWorkmateTM). ECG morphology assessed by 2 observers using digimatic calliper MitutoyoTM. Patients that received pharmacological therapy act as control group. All patients are observed up to 1 year. Results. Sixty two patients underwent RFA (mean age of 43,56 11,77 year,46 female). ECG morphologies are all left bundle branch blok (LBBB), inferior axis, transtitional zone ? V4. Based on ECG morphology, septal site are majority of cases. Mean EA (earliest activation) is 41,26 16,94 ms, median 39,50 ms. An acute successful rate of RFA is 79%.Long termsuccess rate is 83,9 % as compare to only 40,9% in medical therapy group(RRR 77%, p=0.001). Septal origin site is an independent factor of success of RFA RVOT tachycardia. Conclusion. RFA of RVOT tachycardia is safe and effective with better longterm result as compare to pharmacological therapy.