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Introduction: Inappropriate use of oral anticoagulants (OACs) have not been well investigatedand, however, may be frequent in real-world practice in patients with nonvalvular atrial fibrillation (NVAF). This study was designed to evaluate the prescription patterns and appropriateness of OACs in patients with NVAF in real-world clinical settings., Methods: We performed a prospective, observational study (NCT02366338). A total of 148 patients with NVAF were screened for OAC prescription. Appropriateness of prescribing was evaluated using 9 criteria of the Medication Appropriateness Index (MAI): indication, choice, dosage, modalities and practicability of administration, drug-drug interactions, drug-disease interactions, duplication, and duration. For each criterion, the evaluator has to rate whether the medication is (A) appropriate, (B) inappropriate but with limited clinical importance, and (C) inappropriate., Results: Of 148 patients, 73 (50%) were on warfarin (group 1), 39 (26%) were on rivaroxaban (group 2), and 36 (24%) were on dabigatran therapy (group 3). The MAI showed that 83% of group 1, 28% of group 2, and 47% of group 3 patients had at least 1 inappropriate criterion. Moreover, according to the choice criterion, 37% of group 1, 8% of group 2 and 5% of group 3 were rated as inappropriate, and dosage was not appropriate in 77% of group 1, 23% of group 2, and 42% of group 3., Conclusion: Inappropriate drug use is frequent among patients with NVAF not only for warfarin but also for NOACs. Although there is an apparent improvement in thromboprophylaxis of NVAF, much more effort is needed for appropriate use of OACs.

Objective: Impairment of heart rate turbulence (HRT) and heart rate variability (HRV) are associated with poor prognosis in chronic heart failure (CHF). Although previous studies have demonstrated that patients with a left bundle branch block (LBBB) have a better outcome with cardiac resynchronization therapy (CRT), the effect of QRS morphology on HRV and HRT is not known. We aimed to evaluate the effect of QRS morphology on HRV and HRT after CRT implantation in patients with CHF., Patients and Methods: Patients who had been implanted a CRT device with cardioversion-defibrillation feature were included to the study. Forty-three patients with LBBB (group 1) were compared with 21 patients without LBBB (group 2). HRV and HRT parameters were compared before and one month after CRT implantation., Results: We compared the echocardiographic and electrocardiographic changes in both groups after CRT. Cardiac output (CO) was found to be significantly much more increased in group 1 (1.1 ± 0.4 vs. 0.6 ± 0.4, p = 0.001). Similarly, except SDNN and LF, all HRT and HRV parameters were significantly changed in the patients with LBBB (TO 1.4 ± 0.3 vs. 1.2 ± 0.2, p = 0.001; TS -1.8 ± 0.7 vs. -0.9 ± 0.7, p = 0.001; RMSSD -15.7 ± 9.9 vs. -6.3 ± 6.2, p = 0.001; PNN50 -7.0 ± 4.6 vs. -1.7 ± 1.1, p = 0.001; HF -13.3 ± 6.7 vs. -4.3 ± 3.5, p = 0.001; LF/HF 1.9 ± 0.4 vs. 1.5 ± 0.2, p = 0.001) compared to those without LBBB. Lineer regression analysis showed that the CO (β = 0.2, t = 2.8, p = 0.007) and QRS configuration (β = 0.6, t = 0.5, p = 0.001) were independent parameters affecting TO., Conclusions: HRV and HRT are improved after CRT but these improvements are more remarkable in patients with LBBB. CO, QRS configuration (but not duration) were two independent parameters affecting TO, LF and LF/HF ratio after CRT.

Background: Although brain natriuretic peptide (BNP) levels are shown to be an important prognostic factor in patients with acute myocardial infarction (MI), the relationship between arrhythmias and BNP levels is not known. This study assessed whether baseline clinical factors, N-terminal-proBNP (NT-proBNP) levels and electrocardiographic patterns of acute inferior MI are associated with greater risk of developing complete atrioventricular block (CAVB) and mortality., Methods and Results: Seventy-nine consecutive patients (52 male, 27 female with an avarage age of 64.2 ± 10.9 years) with CAVB and 119 control patients (93 male, 16 female with an average age of 57.7 ± 11.4 years) without CAVB were enrolled. Regression analysis revealed that NT-proBNP levels 〉 104 pg/mL increased the development of CAVB by 16.7 folds, 〉 1 mm ST elevation in RV4 by 2.7 folds, ratio of elevation in lead III:II 〉 1.5 by 10.1 folds but the thrombolytic therapy decreased the development of CAVB by 2.8 folds. NT-proBNP 〉 92 pg/mL increased the mortality by 8.9 folds, a ratio of ST-segment elevation in lead III:II 〉 1 by 3.1 folds, ST segment elevation 〉 1 mm in RV4 by 3.5 folds, ejection fraction 〈 35% by 24.2 folds, age 〉 65 years by 8.3 folds and CAVB by 6.8 folds, on contrary thrombolytic treatment decreased the mortality by 3.3 folds., Conclusions: Simple electrocardiographic measurements and NT-proBNP levels at admission can be used as a screening test for development of complications such as CAVB, right ventricular involvement and mortality during acute inferior wall MI.

Background: Hyperthyroidism is a major cause of paroxysmal atrial fibrillation (AF). The purpose of this study was to evaluate the predictors of AF in the patients with clinical and subclinical hyperthyroidism., Methods and Results: The study population consisted of four groups: group I (57 euthyroid healthy persons), group II (33 patients with subclinical hyperthyroidism), group III (69 patients with overt hyperthyroidism) and group IV (31 patients with overt hyperthyroidism and documented paroxysmal AF). The maximum P wave duration (P maximum) in group IV (114 +/- 8 ms) was significantly higher than group I (102 +/- 7 ms, p < 0.001), group II (106 +/- 7 ms, p < 0.001) and group III (108 +/- 9 ms, p0.005). The P wave dispersion (PWD) was measured as 46 +/- 9 ms in group IV and this was significantly higher than group I (29 +/- 8 ms, p < 0.001), group II (36 +/- 9 ms, p < 0.001) and grup III (38 +/- 8 ms, p = 0.001). The P maximum and PWD were higher in the patients with subclinical hyperthyroidism compared to healthy individuals. Univariate regression analysis revealed that age, P maximum and PWD, multivariate analysis showed that P maximum and PWD were significant predictors of paroxysmal AF. A PWD value of 37.5 ms separated group IV from others with a sensitivity of 90%, specificity of 85%, and positive predictive accuracy of 77%., Conclusion: Simply measuring P maximum and PWD values, we could identify the patients with high risk for the development of AF and these simple ECG parameters may help in clinical judgement to determine the requirement for treatment in the patients with subclinical hyperthyroidism.

In this study, the effect of valve replacement on diastolic parameters was evaluated preoperatively and postoperatively at 3, 6, and 12 months by comparing diastolic parameters in patients after aortic valve replacement with freestyle stentless porcine xenografts for aortic stenosis. Depending on deceleration time (DT) and isovolumetric relaxation time (IVRT) with preoperative echocardiographic assessment, patients were divided into two groups: restrictive physiology (DT < or = 150 msec and IVRT < 100 msec, 20 patients), and nonrestrictive physiology (DT > 150 msec and IVRT > or = 100 msec, 27 patients). Although left ventricular mass index significantly decreased in both groups, improvement in DT, IVRT, and ejection fraction occurred only in patients with restrictive physiology. As a result, the patients with restrictive diastolic characteristics had more benefit than the patients with nonrestrictive physiology after aortic valve replacement.