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Brugada syndrome (BS) is a hereditary cardiac channelopathy associated with premature sudden cardiac death and arrhythmic events. However, there are limited data on prevalence of BS in Iran. This study aimed to evaluate the prevalence of BS and Brugada pattern on the electrocardiogram (ECG) in a general population located in south of Iran. BS and Brugada pattern were defined as the presence of type I and type II-III Brugada spontaneously or after a sodium channel blocker test, respectively. A total of 4000 participants (52.3% women) were enrolled in this study. Only 12 patients (0.3%) had Brugada ECG pattern and 4 ECGs were consistent with BS (0.1%). All 16 cases were followed up for 60 months. No mortality or cardiovascular events were observed during this period. This study showed a very low prevalence of BS and Brugada pattern in ECG in the general population of Iran.

Background Tilt Table Test (TTT) is usually used for assessment of syncope with undefined etiology. Positive test occurs in those with parasympathetic overstimulation. This overactivation of parasympathetic system may affect QTc measurement; not only through rate modulation, but also from through potassium ionic channels as muscarinic activated inward rectifying K + current.Methods and Materials: in this cross-sectional study, 478 patients with syncopal attacks of unknown origin underwent evaluation with TTT as well as 24-hour Holter electrocardiogram monitoring. Schwartz score (for diagnosis of Long QT syndrome) was calculated for all of them. Those with secondary causes of long QT excluded from survey. Then the association of positive TTT and Schwartz score was assessed.Results 478 patients entered the study 208 (43.4%) of whom were male and 270 (56.4%) were female. The mean age of the patients was 42.43 ± 17.979 years old. TTT was positive in 289 (60.46%) patients and was negative in 189 (39.54%) patients. the mean Schwartz score was significantly higher in patients with positive TTT (2.77 ± 0.08 vs. 1.99 ± 0.12) (P Conclusion Diagnosis of long QT syndrome as a cause of syncope should not be made hesitantly by the use of Schwartz score as this scoring system might need to be modified based on the results of tilt table test.

The earliest atrial (A)/ventricular (V) activation potentials, or fused A/V potentials, are commonly used as ablation targets for atrioventricular (AV) accessory pathways (APs). However, these targets can be achieved in a relatively wide area of the heart around AV rings at both atrial and ventricular sides. The aim of this study is to analyze the height of intracardiac A and V waves and their correlation to find the most appropriate side for successful delivery of radiofrequency energy, atrial or ventricular edge.Ninety patients diagnosed with orthodromic AV re-entrant tachycardia (AVRT) or Wolff-Parkinson-White syndrome were enrolled. Local atrial/ventricular (A/V) amplitude potentials with the earliest activation or fused AV potentials were measured. Patients were randomly assigned into two groups with a 2:1 ratio. In group 1, ablation was done at the site where A was greater than V. In group 2, V was greater than A. Primary endpoint was success at first attempt, achieving antegrade AP conduction block, AV block during right ventricle pacing, or AVRT termination with no AP conduction.Fifty-one patients (56.7%) were male. Thirty patients had an ablation at an atrial site (A V) and 60 at a ventricular site (V A). Ablation was more successful at the ventricular site (87% vs 100%, P = 0.011). All 30 patients in the atrial arm and 71% of the ventricular group underwent ablation via the antegrade method.Success of catheter ablation of APs is higher where V A (ventricular site of AP), indicating the priority of the ventricular edge of the mitral ring for a better outcome.

Background: Different electrocardiographic (ECG) results, seen in coronavirus disease 2019 (COVID-19) patients are most likely due to the combined impact of acute COVID-19 and chronic heart disease. Few studies have addressed the effects of hypoxemia, the hallmark of the pandemic disease, on ECG. Objectives: The present study discusses the prevalence of arrhythmias and disorders of conduction system in demised and survived COVID-19 patients, using ECG and Sokolow-Lyon voltage as a sign of hypoxemia to predict mortality in the admitted patients and after discharge. Methods: We investigated the ECG, and other medical data of 960 COVID-19 patients admitted to Faghihi hospital in Shiraz, Iran, from August 2021 to December 2021. Results: Most of the patients were male (541 or 56.4%) and older than 65 years old (462 or 48.1%). A total of 475 (49.5%) patients died. Multiple logistic regression revealed an independent association between the COVID-19 death rate and cardiovascular disease (OR = 3.05; 95% CI: 1.96 - 4.74), QT dispersion more than 40 (OR = 5.08; 95% CI: 3.61 - 7.15), heart rate (more than 100 versus less than 60 OR = 2.86; 95% CI: 1.03 - 7.9), ST segment elevation myocardial infarction (OR = 3.93; 95% CI: 2.63 - 5.86), poor progression (OR = 2.33; 95% CI: 1.56 - 3.49), hypertrophy (OR = 1.97; 95% CI: 1.02 - 3.81), and Sokolow-Lyon (OR = 2.91; 95% CI: 1.64 - 5.16). Conclusions: Electrocardiographic examination of COVID-19 patients is important during admission and after discharge. Sokolow-Lyon voltage less than 10 can be regarded as an independent predictor of mortality in COVID-19 patients discharged from hospital.

Cardiac conduction disorders and electrocardiographic (ECG) changes may occur as a manifestation of coronavirus disease 2019 (COVID-19), especially in severe cases.To describe conduction system disorders and their association with other electrocardiographic parameters in patients who died of COVID-19.In this cross-sectional study, electrocardiographic and clinical data of 432 patients who expired from COVID-19 between August 1Among 432 patients who died from COVID-19, atrioventricular block (AVB) was found in 40 (9.3%). Among these 40 patients, 28 (6.5%) suffered from 1st degree AVB, and 12 (2.8%) suffered from complete heart block (CHB). Changes in ST-T wave, compatible with myocardial infarction or localized myocarditis, appeared in 189 (59.0%). Findings compatible with myocardial injury, such as fragmented QRS and prolonged QTc, were found in 91 patients (21.1%) and 28 patients (6.5%), respectively. In patients who died of COVID-19, conduction disorder was unrelated to any underlying medical condition. Fragmented QRS, axis deviation, and ST-T changes were significantly related to conduction system disorder in patients who died of COVID-19 (Conduction system disorders are associated with several other ECG abnormalities, especially those indicative of myocardial ischemia or inflammation. Most patients (73.14%) who died of COVID-19 demonstrated at least one ECG abnormality parameter. Since a COVID-19 patient's ECG gives important information regarding their cardiac health, our findings can help develop a risk stratification method for at-risk COVID-19 patients in future studies.

We describe the first case report of fulminant myocarditis and complete heart block which was initially presented by severe systolic dysfunction and tachyarrhythmia, in a patient who recently recovered from covid-19. Continuous close follow-up should be considered for patients infected with COVID-19 after discharge, especially for those with any metabolic and pharmacologic risk factors for the conductive block to recognize these rare complications and reverse CHB early by administering a high dose of corticosteroid or other anti-inflammatory medications.

Postoperative atrial fibrillation (POAF) is the most frequent dysrhythmias observed following coronary artery bypass graft (CABG) surgery. Several studies have shown the beneficial effects of curcumin on cardiovascular diseases; however, there is no clinical trial to examine its effect on POAF. This randomized, double-blind, placebo-controlled clinical study was designed to evaluate the prophylactic effects of a nano-formulation of curcumin (SinaCurcumin™) versus placebo on POAF and levels of biomarkers of inflammation and oxidative stress in patients undergoing CABG surgery.A total of 234 eligible patients were randomized to receive 240 mg curcumin nano-formulation or placebo three days prior to the surgery and on the first four postoperative days. The occurrence of POAF was monitored for at least 96 hr after the surgery. Also, C-reactive protein (hs-CRP), malondialdehyde (MDA) and glutathione (GSH) levels were assessed at baseline and the end of the study.Analyses were done in the intention-to-treat population. No significant difference was observed in the occurrence of POAF between the treatment (9.5%) and placebo (11.5%) groups. Also, curcumin intervention did not alter serum concentration of the hs-CRP, MDA, or GSH in comparison with placebo.In conclusion, it seems that perioperative treatment with SinaCurcumin™ did not prevent POAF after CABG surgery.

Background More recently, a growing body of literature on COVID-19 has investigated the electrophysiological issues presetting as a disease manifestation of COVID-19 and highlight the spectrum of arrhythmias observed in patients with COVID-19 infection. This Study discuss the prevalence of arrhythmias and conduction system disease in patients with COVID-19. Method electrocardiographic data and comorbidity data of 432 expired COVID-19 patients admitted to Faghihi Hospital of Shiraz University of Medical Sciences from August 1st until December 1st were reviewed. Results AVB was found in 40(9.3%) patients. 28(6.5%) of the patients suffered from 1st degree AVB, and 12(2.8%) suffered from CHB. Changes in ST-T wave compatible with myocardial infarction or localized myocarditis appeared in 189(59.0%) patients. Findings compatible with myocardial injury such as fragmented QRS, and prolonged QTc were assessed with prevalence of 21.1% (91 patients), 6.5% (28 patients). In victims of COVID-19, conduction disease was not related to any underlying medical condition. Fragmented QRS, axis deviation, presence of S1Q3T3 and poor R wave progression were significantly related to conduction system disease in victims of COVID-19 (P value > 0.05, Table 3) Conclusion Our findings can serve in future studies that aim to develop a risk stratification method for susceptible COVID-19 patients. Myocardial injury appears to role significantly in COVID-19 morbidity and mortality. Consequently, we recommend health policymakers to consider separate catheterization laboratories that provide service only to COVID-19 patients.

Aims: Short QT-interval is a condition that bear the suspicion of short QT syndrome (SQTS). SQTS is known to increase risk of life-threatening arrythmias and sudden cardiac death (SCD). Due to the insufficient population-based studies and use of various QT cut-off values it accounts for as an undiagnosed condition. In this study, we sought for prevalence of short QT interval in Kherameh cohort study, one of the southern sectors of the Prospective Epidemiological Research Studies in Iran (PERSIAN).Methods: Data of 4,363 adult subjects were analyzed from phase 1 of the cohort during 2014-2017. The corrected QT (QTc) intervals were calculated and electrocardiograms (ECGs) with QTc of less than 370 milliseconds (msec) were reanalyzed for bradycardia, early repolarization, atrial fibrillation (AF), arrhythmias, and other electrical conduction abnormalities. Results: Seventy-two subjects (1.65%) had a QTc of less than 370msec (mean QTc of 360.72±11.72). A male predominance and a lower mean heart rate observed in SQTS susceptible group (M/F of 1/0.26 vs. 1/1.145, p-valuep-valueConclusion: The prevalence of short QT interval in our cohort was in line with previous studies. The higher proportions of cardiac symptoms, familial SCDs and ECG derived specific findings amongst SQTS-susceptible index persons than non-short QT interval normal population might implicate in gene study and family screening.

Short QT-interval is a condition that bear the suspicion of short QT syndrome (SQTS). SQTS is known to increase risk of life-threatening arrythmias and sudden cardiac death (SCD). Due to the insufficient population-based studies and use of various QT cut-off values, it accounts for as an undiagnosed condition. In this study, we sought for prevalence of short QT interval in Kherameh cohort study, one of the southern branches of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Data of 4363 adult subjects were analyzed from phase 1 of the cohort during 2014–2017. The corrected QT (QTc) intervals were calculated and electrocardiograms (ECGs) with QTc of less than 370 ms (msec) were reanalyzed for bradycardia, early repolarization, atrial fibrillation (AF), arrhythmias, and other electrical conduction abnormalities. Seventy-two subjects (1.65%) had a QTc of less than 370 ms (mean QTc of 360.72 ± 11.72). A male predominance and a lower mean heart rate observed in SQTS susceptible group (M/F of 1/0.26 vs. 1/1.145, p-value p-value

Acceptance of the implantable cardioverter-defibrillator (ICD) device may be affected by a variety of factors. This study aimed to investigate the predictor roles of spiritual well-being, healthcare professionals' support and shock anxiety in accepting ICD.This cross-sectional study was conducted on 100 patients with ICD. The data were collected by the Florida Patient Acceptance Scale, Florida Shock Anxiety Scale, Spiritual Well-Being Scale and Healthcare Professionals' Support Questionnaire.The mean (SD) scores of patient acceptance, shock anxiety, spiritual well-being and healthcare professionals' support were 65.4 (13.56), 21.93 (8.95), 88.92 (11.78) and 76.41 (10.54), respectively. The results revealed higher acceptance among the participants with lower shock anxiety levels (The study results indicated that the patients' mean score of acceptance was relatively high. In addition, the mean scores of shock anxiety, spiritual well-being and healthcare professionals' support were low, moderate and relatively high, respectively. Conducting healthcare professionals' support interventions, spiritual therapy and reducing shock anxiety can help patients accept ICDs.

Introduction: Implantable cardioverter defibrillator (ICD) plays a life-saving role via controlling malignant dysrhythmias. However, it may result in the incidence of psychological tensions in patients’ lives, eventually leading to changes in their quality of life (QoL). To date, this association has remained unclear among Iranian population. Therefore, the present study aimed to determine the association between QoL and psychological issues in patients with ICD. Methods: Using convenience sampling method, this cross-sectional study was conducted on 96 patients referred to the pacemaker clinic of Shahid Faghihi hospital and Kowsar heart hospital affiliated to Shiraz University of Medical Sciences, Iran from September 2016 to January 2017. The data were collected using Depression, Anxiety, Stress Scale (DASS-21) and the Short Form-36 (SF-36) questionnaire, and analyzed in SPSS software version 13 using independent t-test, Pearson’s correlation test, and ANOVA. Results: The mean (SD) score of patients’ QoL was found to be 1672.02 (43.43). Moreover, the mean (SD) scores of depression, anxiety, and stress were 4.69 (0.46), 5.6 (0.47), and 7.51 (0.05), respectively indicating moderate depression, anxiety, and stress levels among the patients. A significant association was found between the patients’ QoL and depression, anxiety, and stress. Conclusion: As an association was observed between the patients’ QoL and depression, anxiety, and stress, performing some interventions to reduce the patients’ psychological issues might improve their QoL.

Background: Binge alcohol eating especially in underdeveloped countries may be complicated by methanol toxicity, especially when blinded drunken cases come to emergency department. Unfortunately, in early months of 2020, Fars, one of the largest provinces in southern Iran, reported one of the largest methanol poisoning outbreaks with high case-fatality rate. Here we like to share our experience and introduce some simple measures which may announce more urgent dialysis to save the lives of these patients.Method: In this study, 356 cases with methanol toxicity referred to the Tertiary Hospitals (Faghihi and Namazi) affiliated to Shiraz University of Medical Sciences during March and April, 2020. To collect the required data, clinical findings on blindness and impaired level of consciousness, laboratory data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. Results: Among the participants, 321 (90.2%) patients were male, and 162 persons (45.5%) were aged below 30 years old. Reviewing the laboratory data of the included patients revealed that PH, HCO3, and O2 saturation decreased. While PCO2, Cr, K, BS increased (P=70, Brugada pattern, low voltage QRS, severe metabolic acidosis (PHConclusion: Apart from usual modalities like acidosis, electrolyte imbalance, QTc prolongation and prominent U wave, we found Brugada like ECG, notch in QRS and steeply terminal T wave more than 70 degrees to be ominous signs and need urgent attention.

Introduction: Brugada phenocopies are recently introduced as clinical entities with electrocardiographic patterns identical to true congenital Brugada syndrome in individuals, who are asymptomatic and have no other clinical criteria. One of the largest methanol poisoning outbreaks occurred in Iran during March and April 2020. This study aimed to investigate the relationship between Brugada Phenocopy with laboratory data and demographic factors and determine its association with mortality rate in methanol toxicity patients. Method and results: Demographic data such as age, gender, medical history, Glasgow coma scale score, laboratory data, and electrocardiographic data were obtained from 356 patients, who were diagnosed with methanol poisoning and were hospitalized in Faghihi and Namazi Hospitals in Shiraz, southern Iran, during March and April 2020. The follow-up data was gathered to examine the development of any complications or death. A total of 20 (5.6%) patients were admitted with a diagnosis of methanol toxicity and concurrent Brugada-like ECG patterns. Mortality rate, Glasgow Coma Scale Score

The importance of venous structure in the heart is usually overshadowed by that of the arterial system. Coronary sinus (CS) is a part of cardiac venous apparatus and connects left atria to the right atria. Other than having role in physiological contractions of both atria, it contributes substantially to cardiac electrical conduction system. Due to unique placement and connections of the CS, it has become growing interest in clinical cardiology. It is used in cardiac resynchronization therapy with biventricular pacing, left-sided catheter ablation of arrhythmias, and administration of retrograde cardioplegia in cardiac surgery. In some individuals, CS is presented with anatomical variants. CS diverticulum is a congenital outpouching that provides muscular connection between atria and ventricle. This connection provides a suitable substrate for occurrence of arrhythmias, which even results in life-threatening events such as sudden cardiac death. Early diagnosis leads to treatment with ablation techniques, which ultimately eliminates origins of arrhythmias.

Background Methanol is widely used in industry; however, methanol poisoning is not common. In this regard, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz, a city located in the southern part of Iran, faced one of such outbreaks in 2020 during COVID-19 pandemic. There is no sufficient literature on the electrocardiographic findings in methanol toxicity. This study aimed to address this gap in the literature. Method A total of 356 cases with methanol toxicity referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April, 2020. The clinical findings of blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. Results The most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases. This finding, to the best of our knowledge, has only been reported in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were the other interesting findings. In multivariate analysis, when confounding factors were adjusted, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia, and the prolonged QTC > 500 msecond were four independent factors correlated with methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with odds ratios of 12.82, 4.46, 2.32 and 3.15 (P Conclusion Electrocardiographic variations during methanol intoxication are remarkable and well-correlated with poisoning severity. Myocardial infarction was an egregious and yet a common concerning finding in this sample, which need to be ruled out in methanol toxicity.

Introduction: Cardiac dysfunction is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Previous studies have shown that kidney transplantation can reverse some of the gross changes in the myocardial structure such as left ventricular ejection fraction (LVEF) and volumes. Whether kidney transplantation can reverse the subtle and early myocardial changes in ESRD patients who do not suffer from gross alternations in myocardial function is not yet studied. The aim of this study was to answer this question. Methods: We followed 25 patients with ESRD at baseline that all of them had a kidney transplant and were reassessed 1 month after the transplantation. Conventional and speckle tracking echocardiography (STE)was done at baseline and 1 month after kidney transplantation in patients. Results: LV hypertrophy was the most prevalent finding at baseline (58%), followed by diastolic dysfunction (53%). Kidney transplantation significantly improved the ejection fraction (EF) (treatment effect = 4.23 ± 2.06%; P = 0.046) and apical 4-chamber strain (treatment effect = -0.89 ± 0.37%; P = 0.021) in the patients. It also reduced the LV mass index (treatment effect = -73.82 ± 11.6; P < 0.001) and relative wall thickness (treatment effect = -0.056±0.023; P = 0.021). Other variables including global longitudinal strain and diastolic dysfunction were not improved significantly. Conclusion: STE may show early improvements in myocardial function 1 month after renal transplantation.

Aims In previous retrospective studies, it was shown that the presence of residual single atrioventricular node (AVN) echoes with an echo zone longer than 30 ms may increase the rate of recurrence after radiofrequency ablation (RFA) of slow pathway in patients with AVN reentrant tachycardia (AVNRT). Based on that, some centres perform additional RFA in these patients. However, this opinion has never been tested prospectively and many centres do not perform re-ablation in these patients. The purpose of this study was to test whether persistence of a single AVN echo over a wide echo zone is a valid end point for RFA. Methods and results In this prospective study, 576 patients who had a non-inducible arrhythmia post-RFA of AVNRT were divided into those with a remnant echo over a wide echo zone (case group) and those reaching classical end points (control group). The primary end point of the study was recurrence and patients were followed for 34.5 ± 18.8 months. In the control group (n = 510), 14 patients (2.7%) had a recurrence while no recurrence was seen in the case group (n = 66) (final cure rate, 97.3 vs. 100%; difference, 2.7%; upper bound of the 98% CI, 0.0488; P

BackgroundSeveral studies addressed the association between fragmented QRS (fQRS) on 12-lead EKG and left ventricular (LV) dysfunction in patients with a variety of cardiovascular disorders. We tested such association in healthy individuals.MethodsOut of 500 healthy participants without -overt cardiovascular disease from the Shiraz Heart Study cohort, we identified 20 subjects with fQRS (cases) and 20 peers without fQRS (controls). Global LV longitudinal strain (GLS) was measured by speckle tracking echocardiography in the two groups. Comparison was made between case and control groups by using chi-square or independent sample t-test or ANOVA.ResultsAge, gender, ejection fraction, LV volume and dimensions did not differ between the case and the control groups. Overall, 14 subjects out of 40 had reduced GLS (≤20%) and 10 of them (25%) had fQRS. GLS was significantly lower in the group with fQRS than in the control group (19.9 ± 1.8 vs 21.4 ± 1.6;p = 0.009).ConclusionsHealthy subjects with fQRS present regional LV systolic dysfunction, assessed by GLS, in the presence of a normal ejection fraction. These data suggest that fQRS may be a promising tool to identify apparently healthy subjects with regional LV systolic dysfunction.

Objectives. Catheter ablation is an effective method in the treatment of idiopathic ventricular arrhythmias. The mapping methods used for predicting the original site of arrhythmias are difficult t...

Background Adenosine triphosphate (ATP)-binding-cassette-transporter-A1 (ABCA1) transports cholesterol from cells into apolipoprotein A1 to form high-density lipoprotein (HDL) cholesterol. Methods We investigated the frequencies of ABCA1 functional variants in 273 patients with coronary artery disease (CAD) and 261 age-matched, healthy blood donors in southwest Iran. Sequence-specific primer polymerase-chain reaction (SSP-PCR) and polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP) were used for genotyping. Results Frequencies of the rs2422493-TT genotype and T-allele, rs1800976-GG genotype, and G-allele in the promoter and rs2230806-GG genotype and G allele in the exon of the ABCA1 gene were higher in the patients. Abnormal left ventricular size and left-artery disease correlated with rs2422493-T and rs1800976-G alleles, respectively. Wall-motion abnormalities correlated with the rs1883025-G allele and rs2230806-A allele. Regarding the rs2422493/rs1800976/rs2230806/rs1883025 haplotype, T-G-G-A and T-G-A-A were more frequent in case individuals, whereas C-C-G-G was more frequent in control individuals. Conclusions The rs2422493-T allele and the rs1800976-G allele increase the risk of disease, as single polymorphisms and in the haplotype. The effect of the rs1883025-G allele is prominent in the haplotype, rather than individually. Considering that G allele of rs2230806 in the third place is present in both susceptible and protective haplotypes, the susceptibility haplotype can be defined as T-G-X-A.

Introduction: End stage renal disease (ESRD) reasons several changes in the function of thyroid gland as; lower levels of thyroid hormones, altered hormone metabolism, and increased iodine storage. The aim of this study was to evaluate the prevalence of nodular goiter and hypothyroidism in hemodialysis (HD) patients compared with normal population. Methods: This cross-sectional study was conducted among HD patients and healthy people as the control group for thyroid function evaluation. Thyroid gland was evaluated by physical examination and ultrasonography. Blood level of FT3, FT4, TSH, TPO Ab, and urinary iodine excretion were checked in both groups. Data were analyzed using SPSS-17 and P-value less than 0.05 was considered as the significance level. Findings: Eighty six HD patients (57.2 ± 17.2 mean age, 48 men) and 86 healthy people (56.6 ± 16.8 mean age, 48 men) were enrolled in this study. Goiter was confirmed by physical examination in 29.0% of the HD patients and 12.8% of the control group (P = 0.04). Nodular goiter that was shown by ultrasonography was found in 27.9% and 3.5% of the HD and control groups, respectively (P = 0.01). HD patients had a higher frequency of reduced FT3 (40.9% vs. 4.6%, P

Using Electrocardiographic criteria is usual for determining the best site for ablating accessory pathways. Many algorithms are present in this regard, but there are still many facts to be found. The present study aimed to reduce fluoroscopic time by using a special electrocardiographic sign. This study was performed on a young lady with palpitation, negative delta wave in V1 and V3, and positive delta wave in V2. Positive delta in V2 intervened with negative delta in V1 and V3 localized in the crux area for accessory pathway. This might help reduce the procedure time and increase the success rate. This exceptional electrocardiography could be used to locate the site of ablation, increase the rate of success, and reduce radiation exposure.

Background Cardiac resynchronisation therapy (CRT) is an accepted device therapy in patients with low ejection fraction. Beneficial effects of CRT result from mechanical remodelling. Some controversial reports suggest that CRT may also induce electrical remodelling with intrinsic QRS narrowing but still the effect of CRT on electrical remodelling is an issue for debate. The aim of our study was to evaluate the effects of CRT on intrinsic QRS duration. For clarity, our analysis was performed by the signal averaged electrocardiogram (SAECG) which is a high resolution electrocardiographic signal suitable for accurate measurement of QRS duration. Signal averaged electrocardiogram provides a better value of QRS duration compared to 12-lead ECG by the ability to detect ventricular late potentials. Methods A total of 48 consecutive patients with severe systolic dysfunction and typical left bundle branch block (LBBB) were enrolled in the study prospectively. Patients were scheduled for CRT-D implantation according to the current guidelines. Intrinsic QRS duration was accurately measured by SAECG before and at least 14 months after CRT implantation. Results The mean intrinsic QRS duration remained unchanged during follow-up (from 149.9 ± 13.8 ms to 149.6 ± 18.4 ms; P= 0.3). Among 32 CRT responder patients, the mean intrinsic QRS duration remained unchanged during follow-up. Also, the mean intrinsic QRS duration showed no significant changes in 16 CRT non-responders. Conclusion Structural remodelling induced by CRT does not necessarily translate into decrease of intrinsic ventricular activation. Despite significant left ventricular recovery, electrical characteristics of the left ventricular conduction system cannot generally be expected to recuperate.

Background This study aimed to determine the effect of lemon (Limon Citrus) inhalation aromatherapy on Blood Pressure (BP), electrocardiogram changes, and anxiety in patients with Acute Myocardial Infarction (AMI). Methods In this clinical trial, 100 AMI patients were assigned to intervention (received lemon inhalation aromatherapy) and control (received paraffin) groups. Aromatherapy was conducted for three consecutive days. BP, electrocardiogram changes, and anxiety were assessed. Results A significant difference was observed between the two groups concerning systolic BP and percentage of ST-segment and T wave changes on the 3rd and 4th days after the intervention. A significant difference was also found between the two groups concerning heart rate and anxiety on the 4th day after the intervention. Conclusion As lemon inhalation aromatherapy in AMI reduced systolic BP, anxiety, and percentage of ST-segment and T wave changes and regulated heart rate, using this kind of aromatherapy is suggested in coronary care units. Clinical trial registry The study was registered in the Iranian Registry of Clinical Trials (IRCT registration number: 33151, 2018/09/22).

IntroductionThe significant increase in the rate of morbidity and mortality due to cardiovascular diseases has become a health challenge globally. Lack of enough knowledge on the underlying causes in Iran and taking the unique characteristics of the Shiraz metropolitan city (the capital city of Fars Province) into consideration prompted us to conduct the Shiraz Heart Study. The aim of this study is to determine the predisposing elements leading to coronary heart disease, cerebrovascular disease and peripheral arterial disease.Methods and analysisIn this population-based, prospective study, family physician clinics will become the executive arms. Participants aged 40–70 years old will be recruited to achieve a sample size of 10 000. Socioeconomicta and anthropometric indices supplemented by physical activity, nutritional and psychological questionnaires, as well as routine blood laboratory tests, medical history and electrocardiographic records, will be collected at enrolment in clinics. In addition, blood samples will be obtained to explore the possible role of genetics in outcome occurrence. Follow-up with blood sampling, completion of a lifestyle questionnaire and evaluation of clinical risk factors will be carried out five times in a 2-year interval for all participants. Advanced statistical methods such as mixed model and time-to-event models will be used for data analysis.Ethics and disseminationThis study is in accordance with the Helsinki Declaration and has been approved by the Research Ethics Committee of Shiraz University of Medical Sciences (No: 2017–358). Signing a written informed consent is the preliminary step. Participants are free to withdraw on their request at any time. Collected data are kept encrypted in a software with authorities’ access only. Findings of the study will be published at a national or international scale through peer-reviewed journals.

Summary Background/Purpose Abnormality in cardiac structure and function is common in chronic kidney disease (CKD) patients. We aimed to evaluate the prevalence of different abnormal echocardiographic findings in CKD patients and find their associated factors. Methods This retrospective cross-sectional study was conducted in the Nephrology and Dialysis Department of the Shiraz University of Medical Sciences. A total number of 1354 kidney transplant candidates between the years 2000 and 2010 were included. Association between variables was assessed by Chi-square test and Student t test. We analyzed our data using multivariate logistic and linear regression when appropriate. Results Left ventricular hypertrophy (LVH; 47.5%) was the most common finding in this study, followed by left atrial enlargement (43.7%), diastolic dysfunction (25.4%), left ventricular end diastolic dilation (23.1%), and systolic dysfunction (18.5%), in order of frequency. Older age was associated with abnormality in all echocardiographic indexes. Male gender was associated with LVH and systolic dysfunction. We found an association between a longer duration since CKD diagnosis and LVH. Left ventricular end diastolic dilation, left atrial enlargement, and diastolic dysfunction were associated with a longer duration of dialysis. Anemia was associated with all echocardiographic abnormalities except diastolic dysfunction. Hypoalbuminemia and hypocalcemia were associated with only left atrial enlargement and left ventricular end diastolic dilation, respectively. Patients on peritoneal dialysis had a lower prevalence of left atrial enlargement and left ventricular end diastolic dilation. Conclusion Different echocardiographic abnormalities, especially LVH, are prevalent among CKD patients. Traditional risk factors, such as age, diabetes mellitus, and hypertension, and uremia-related risk factors, such as anemia and hypoalbuminemia, are associated with an increase in the prevalence of these abnormalities. 背景：心臟結構及功能異常在慢性腎病患者 (CKD) 間相當常見，本研究旨在調查 CKD 患者間心臟超音波異常表現的盛行狀況及其中的相關因子。 方法：這是伊朗設拉子醫學大學腎臟醫學與透析部的一項回溯性橫斷研究，納入 2000 至 2010 年間共 1354 位移植候選者，並採用卡方檢定及 Student's t test 以檢定各變項間的關聯性。 結果：最常見的發現依序有：左心室肥大 (LVH) (47.5%)、左心房擴大 (43.7%)、舒張功能障礙 (25.4%)、左心室舒張末擴張 (23.1%)、及收縮功能障礙 (18.5%)。所有心臟超音波指標的異常均與年老有關，其中 LVH 及收縮功能障礙與男性性別有關。我們亦發現 LVH 與 CKD 診斷後的較長時間有關；左心室舒張末擴張、左心房擴大、及舒張功能障礙則與較長的透析時間有關。除了舒張功能障礙之外，貧血與所有的心臟超音波異常均有關。低白蛋白血症及低鈣血症，則分別僅與左心房擴大及左心室舒張末擴張有關。在正接受腹膜透析的病人間，左心房擴大及左心室舒張末擴張的盛行率均較低。 結論：心臟超音波指標異常特別是 LVH 在 CKD 患者間相當常見，它們的出現與傳統的危險因子有關，例如年齡、糖尿病、及高血壓；及尿毒症的相關危險因子如貧血及低白蛋白血症。

End stage renal disease (ESRD) reasons several changes in the function of thyroid gland as; lower levels of thyroid hormones, altered hormone metabolism, and increased iodine storage. The aim of this study was to evaluate the prevalence of nodular goiter and hypothyroidism in hemodialysis (HD) patients compared with normal population.This cross-sectional study was conducted among HD patients and healthy people as the control group for thyroid function evaluation. Thyroid gland was evaluated by physical examination and ultrasonography. Blood level of FT3, FT4, TSH, TPO Ab, and urinary iodine excretion were checked in both groups. Data were analyzed using SPSS-17 and P-value less than 0.05 was considered as the significance level.Eighty six HD patients (57.2 ± 17.2 mean age, 48 men) and 86 healthy people (56.6 ± 16.8 mean age, 48 men) were enrolled in this study. Goiter was confirmed by physical examination in 29.0% of the HD patients and 12.8% of the control group (P = 0.04). Nodular goiter that was shown by ultrasonography was found in 27.9% and 3.5% of the HD and control groups, respectively (P = 0.01). HD patients had a higher frequency of reduced FT3 (40.9% vs. 4.6%, P 0.01) and increased TSH (18.6% vs. 8.1%, P 0.03(. TPO Ab was positive in 15.1% of the HD and 11.6% of the control groups (P = 0.14).The high incidence of nodular goiter and hypothyroidism in ESRD patients shows that screening for thyroid dysfunction and goiter, using appropriate laboratory tests, should be considered in evaluations of ESRD patients.