Search

Purpose Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint™ Pacing, MPP) has been shown to improve CRT response, although MPP response using automated pacing vector programming has not been demonstrated in the Middle East. The purpose of this study was to compare the impact of MPP to conventional biventricular pacing (BiV) using echocardiographic and clinical changes at 6-month post-implant. Methods This prospective, randomized study was conducted at 13 Middle Eastern centers. After de novo CRT-D implant (Abbott Unify Quadra MP™ or Quadra Assura MP™) with quadripolar LV lead (Abbott Quartet™), patients were randomized to either BiV or MPP therapy. In BiV patients, the LV pacing vector was selected per standard practice; in MPP patients, the two LV pacing vectors were selected automatically using VectSelect. CRT response was defined at 6-month post-implant by a reduction in LV end-systolic volume (ESV) ≥ 15%. Results One hundred and forty-two patients (61 years old, 68% male, NYHA class II/III/IV 19%/75%/6%, 33% ischemic, 57% hypertension, 52% diabetes, 158 ms QRS, 25.8% ejection fraction [EF]) were randomized to either BiV (N = 69) or MPP (N = 73). After 6 months, MPP vs. BiV patients experienced greater ESV reduction (25.0% vs. 15.3%, P = 0.08), greater EF improvement (11.9% vs. 8.6%, P = 0.36), significantly greater ESV response rate (68.5% vs. 50.7%, P = 0.04), and significantly greater NYHA class improvement rate (80.8% vs. 60.3%, P = 0.01). Conclusions With MPP and automatic LV vector selection, more CRT patients in the Middle East experienced reverse remodeling and clinical improvement relative to conventional BiV pacing.

Objectives Despite its wide usage, warfarin therapy remains challenging due to its narrow therapeutic index, inter-individual response variability, and risk of bleeding. Previous reports have suggested that polymorphisms in VKORC1 and CYP2C9 genes could influence warfarin therapy. Herein, we investigated whether VKORC1 −1173C>T, CYP2C9*2, and CYP2C9*3 gene polymorphisms are associated with warfarin dose adjustment and related bleeding events. Methods This cross-sectional study was conducted on Saudi adults receiving warfarin for more than 1 month. Their demographics and relevant clinical data were obtained. Genotyping for VKORC1 −1173C>T, CYP2C9*2, and CYP2C9*2 genotypes was performed. Results Patients who are homozygous for the mutant T allele VKORC1 T/T required the lowest warfarin daily maintenance dose, compared to VKORC1 C/T and VKORC1 C/C. Similarly, there was a significant reduction in warfarin daily maintenance dose among CYP2C9*1/*3 and CYP2C9*1/*2 groups compared to CYP2C9*1/*1. However, we found no significant correlation between the studied polymorphisms and warfarin-associated bleeding. Conclusions Similar to other populations, the VKORC1 and CYP2C9 gene polymorphisms are significantly associated with warfarin dosage in Saudi patients. The presence of at least one copy of the mutant alleles for VKORC1 −1173C>T, CYP2C9*2, and CYP2C9*3 is associated with a significant reduction in warfarin maintenance dose.

Despite its wide usage, warfarin therapy remains challenging due to its narrow therapeutic index, inter-individual response variability, and risk of bleeding. Previous reports have suggested that polymorphisms inThis cross-sectional study was conducted on Saudi adults receiving warfarin for more than 1 month. Their demographics and relevant clinical data were obtained. Genotyping forPatients who are homozygous for the mutant T alleleSimilar to other populations, the

Retinal arterial macroaneurysms with supravalvular pulmonic stenosis (RAMSVPS), also known as Familial Retinal Arterial Macroaneurysms (FRAM) syndrome, is a very rare multisystem disorder. Here, we present a case series comprising ophthalmologic and systemic evaluation of patients homozygous for RAMSVPS syndrome causative IGFBP7 variant. New clinical details on 22 previously published and 8 previously unpublished patients are described. Age at first presentation ranged from 1 to 34 years. The classical feature of macroaneurysms and vascular beading involving the retinal arteries was universal. Follow up extending up to 14 years after initial diagnosis revealed recurrent episodes of bleeding and leakage from macroaneurysms in 55% and 59% of patients, respectively. The majority of patients who underwent echocardiography (18/23) showed evidence of heart involvement, most characteristically pulmonary (valvular or supravalvular) stenosis, often requiring surgical correction (12/18). Four patients died in the course of the study from complications of pulmonary stenosis, cerebral hemorrhage, and cardiac complications. Liver involvement (usually cirrhosis) was observed in eight patients. Cerebral vascular involvement was observed in one patient, and stroke was observed in two. We conclude that RAMSVPS is a recognizable syndrome characterized by a high burden of ocular and systemic morbidity, and risk of premature death. Recommendations are proposed for early detection and management of these complications.

Background Left ventricular hypertrophy (LVH), as assessed by measurement of left ventricular mass (LVM), is one of the most important cardiovascular risk factors. It is commonly present in patients with ischemic heart disease (IHD), irrespective of the level of blood pressure; recently, oxidative stress has been shown to be an important factor in its development. The question then arises: can this risk factor be modified by antioxidant treatment (e.g., with allopurinol, a xanthine oxidase inhibitor)? Methods This is an observational study with a cross-sectional design which explored the association between long-term (>12 months) allopurinol therapy and LV mass index (LVMI) as well as geometry in patients generally receiving standard treatments for IHD. The primary endpoint was LVMI measurement (by 2D-echocardiography) and secondary endpoints included the association of allopurinol use with LV function (ejection fraction), blood pressure, glycemic control, and lipid profile. Results Ninety-six patients on standard anti-ischemic drug treatment (control group) and 96 patients who were additionally taking allopurinol (minimum dose 100 mg/day) were enrolled. Both groups were matched for age, sex, height, and co-morbidities, but poorer kidney function in the allopurinol group required further sub-group analysis based on renal function. Allopurinol treatment was associated with the lowest LVMI in the patients with normal serum creatinine (median LVMI; 70.5 g/m2): corresponding values were 76.0 and 87.0 in the control group with, respectively, normal and elevated serum creatinine, and 89.5 in the allopurinol group with elevated serum creatinine (P=0.027). In addition, allopurinol was associated with better glycemic control (HbA1c) with a difference of 0.8% (95% CI; 1.3, 0.2) (P=0.004) as compared with control patients. Conclusion In our population, treatment with allopurinol (presumably because of its anti-oxidant properties) has shown a tendency to be associated with smaller LVM in IHD patients with normal serum creatinine, along with better glycemic control.

Background: Fasting during Ramadan is considered one of the most sacred Islamic rituals. To our knowledge, there is no data about Ramadan fasting in heart transplant recipients. Objectives: To assess the ability of heart transplant recipients to fast the month of Ramadan and to study the fasting effects on their clinical condition Design: A cross-sectional study of heart transplant recipients attending the heart transplant clinic in the three months following Ramadan in 1439 and 1440 Hijri (May-June 2018 and 2019). Setting: Heart transplant clinic in a tertiary care hospital in the Kingdom of Saudi Arabia. Patients and Methods: Heart transplant recipients attending the heart transplant clinic in the Heart Center at King Faisal Specialist Hospital & Research Center (KFSH&RC), Riyadh. Data about Ramadan fasting was documented using standard case report form (CRF), and data were collected from the medical records about their clinical and laboratory findings before and after Ramadan. Main Outcome Measures: Ability of heart transplant receipts to fast during Ramadan and the effect of fasting on their medical condition. Sample Size: One hundred twenty heart transplant recipients were approached to participate in this study. Ninety-two patients agreed to participate in the study with seventy-eight patients fasted during Ramadan. Results: Seventy-eight patients were able to fast Ramadan (84.8%). In comparison to the months before and after Ramadan, 44 of the fasting patients (56.4%) reported no change in their overall health, 29 patients (37.2%) reported feeling better, and 5 patients (6.4%) reported feeling worse during fasting. Sixty patients (76.9%) reported no significant new symptoms, and 18 patients (23.08%) reported one or more new symptoms. Conclusions: It seems that the majority of heart transplant recipients beyond one year of transplantation can fast Ramadan without having significant medical issues Limitations: The small number of participants and the limitations of cross-sectional design.

Confidentiality and data integrity are two important security services that are provided by the most popular VPN protocols such IPsec and SSL/TLS. It is a well-known fact that security comes at the cost of performance, and performance is affected by the cryptographic algorithms and their execution. In this study, confidentiality and data integrity processes were implemented using client--server Java applications in a real LAN to assess their performance based on different encryptions methods. The execution time of data encryption, data decryption, and data integrity verification was measured and total session times were computed for the following encryption algorithms AES, Blowfish, 3DES, RC2, MD5, and SHA-1. The observation results have been analyzed and the performance of these encryption algorithms and digest ciphers was compared, interpreted, and outlined in terms of total session time and different security parameters (data integrity, encryption, decryption, and data integrity verification).

Nonbacterial thrombotic endocarditis, a form of noninfectious thrombotic endocarditis, is mainly characterized by deposition of sterile platelet thrombi on heart valves. Usually, it is observed in advanced malignancy. Herein, we report a case of a previously healthy male with recent unprovoked deep vein thrombosis presented with acute ischemic stroke. The echocardiogram revealed aortic and mitral valve masses. Eventually, he was discovered to have advanced cholangiocarcinoma. The present case, apart from being the youngest reported case, is among the few reported cases which manifest the association between cholangiocarcinoma and nonbacterial thrombotic endocarditis.

Sick sinus syndrome (SSS) is a group of disorders characterized by an abnormal cardiac impulse formation or propagation from the sinoatrial node. Mutated SCN5A has been reported in SSS, however, homozygosity of SCN5A is exceedingly rare. Here, we report a consanguineous family with four affected children with SSS. Symptomatic bradycardia necessitated implanting a pacemaker in all of them. Sequencing SCN5A revealed a novel homozygous variant (p.Cys1850Arg), which was predicted to interfere with protein folding. Our report describes the phenotype of a novel homozygous SCN5A variant and contributes to the compendium of molecular pathology of inherited arrhythmias in consanguineous populations.

Sudden Cardiac Death (SCD) is a significant health problem worldwide. Multiple randomized controlled trials have shown that Implantable Cardioverter Defibrillators (ICDs) are effective life-saving management option for individuals at risk of SCD in both primary and secondary prevention. Although the conventional transvenous ICDs (TV-ICDs) are safe and effective, there are potential complications associated with its use, including localized pocket or wound infection or systematic infection, a vascular access related complication such as pneumothorax, and venous thrombosis, and lead related complications such as dislodgement, malfunction, and perforation. Furthermore, transvenous leads placement may not be feasible in certain patients like those with venous anomaly or occlusion, or with the presence of intracardiac shunts. Transvenous leads extraction, when needed, is associated with considerable morbidity & mortality and requires significant skills and costs. Totally subcutaneous ICD (S-ICD) is designed to afford the same life-saving benefit of the conventional TV-ICDs while avoiding the shortcomings of the TV-leads and to simplify the implant techniques and hence expand the use of ICDs in clinical practice. It becomes commercially available after receiving CE mark in 2009, and its use increased significantly after its FDA approval in 2012. This review aims to give an overview of the S-ICD system components, implantation procedure, clinical indications, safety, efficacy, and future directions.

Background Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited cardiomyopathy characterized histologically by the replacement of ventricular myocardium with fibrous and fatty tissue, and clinically by ventricular tachycardia arrhythmias primarily of right ventricular (RV) origin. Implantable cardioverter defibrillator (ICD) is the only proven therapy to reduce mortality in ARVC/D patients. However, it has the risk of inappropriate anti-tachycardia pacing (ATP) or shocks. This study aimed to assess the occurrence of appropriate and inappropriate ICD therapies in ARVC/D patients who underwent ICD implantation in a single Cardiac Centre. Methods Retrospective analysis of the data of patients with the diagnosis of ARVC/D based on the 2010 revised Task Force Criteria, who underwent ICD implantation in the Heart Centre, at King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh between January 1997 and May 2016. The clinical data and information about appropriate and inappropriate ICD therapies were obtained from medical records with the review of the available intra-cardiac electrograms (EGMs). Results Twenty-two ARVC/D patients with ICD implantation (20 males (91%), mean age at ICD implantation: 32 ± 14 years). ICD was implanted for secondary prevention of sudden cardiac death (SCD) in 15 patients (68.2%), and for primary prevention in 7 patients (31.8%). At mean follow-up of 9.4 ± 4.8 years, 11 patients (50%) had appropriate ICD therapies, and five patients (22.7%) had inappropriate ICD therapies. Out of 950 ICD therapies, 865 (91%) were appropriate (586 episodes of VT/VF treated with ATP (61.3%), and 279 episodes treated with shocks (29.37%)) and 85 (9.4%) were inappropriate (45 episodes treated with ATP (4.73%), and 40 treated with shocks (4.21%)). Conclusion ARVC/D patients are at risk of VT/VF arrhythmias. ICD therapy is the only proven life-saving therapy in those patients. Most of ICD therapies in our patient’s population are appropriate, and ATP therapy is effective in terminating most of VT episodes. Although we do not have any patient with subcutaneous ICD, the high success rate of ATP suggests that transvenous ICD would be more appropriate in ARVC/D patients.

Tricuspid valve dysfunction and in particular tricuspid stenosis has recently been described secondary to cardiac implantable electronic devices. The valve is subjected to different mechanisms of injury related to the endocardial lead passing through its plane. The lead can form a loop or perforate one of the leaflets and initiate inflammatory response and fibrotic changes. Multimodality cardiac imaging is required to diagnose this clinical entity and decide on the best treatment plan. Here we present a case of a young female who developed tricuspid stenosis secondary to permanent pacemaker lead that was implanted 24 years before. We performed a review for all cases reported in the literature with a similar condition and various treatment approaches. .

Gitelman syndrome (GS) is an autosomal recessive tubulopathy recently implicated in cases with ventricular arrhythmias (VAs), the latter being considered linked to electrolytes’ imbalance. However, a direct causal relationship is considered to be an oversimplification for a complex molecular dysfunction. Recent work has suggested a degree of microvascular dysfunction in patients with GS that might be attributed as a mechanism of arrhythmia. We report a case of GS presenting with VAs complicated by cardiomyopathy. The high load of premature ventricular contractions that were attributed to the hypokalaemia has masked the presence of the left ventricular (LV) outflow tract tachycardia. Her LV systolic function recovered after successful electrophysiology ablation procedure. Atrioventricular nodal re-entry tachycardia was discovered incidentally during the study and was ablated successfully.

Recently, Blockchain (BC) attracts a lot of research’s to study their salient features in order to adopt it into various domains. BC promise to address security and privacy preservation issues in a distributed manner and eliminating the centralized concept. However, Internet of Thing (IoT) environments is constricted resources with limited capabilities in terms of; computation, storage, and energy that deter to adopt BC in a straightforward manner due to its intensive computational requirements and bandwidth consumption overhead. To address those issues, this paper introduces a Lightweight Blockchain based Cybersecurity (LBC) for IoT environments. Unlike the Proof of Work (PoS) and Proof of Stake (PoS) in Bitcoins, we aim to mitigate the heavy computational cost that required in a consensus algorithm to meet the IoT requirements. To provide scalability feature to the proposed scheme, Edge Block Manager (EBM) and Aggregation Block Managers (ABM) have been introduced; where EBM aims to overcome the limited capabilities of local IoT resources and manages local BC in centralized manner. While ABM constitute of numerous of EBM to manages the public BC in a distributed manner. Our novel proposed scheme can preserve high throughput and low latency. Obviously, waiting period, verification, and block appending period have been mitigated. Security analysis shows that the proposed scheme is resisted against typical attacks.

Infections after placement of cardiac implantable electronic devices (CIEDs) are associated with substantial morbidity and mortality. There is limited evidence on prophylactic strategies, other than the use of preoperative antibiotics, to prevent such infections.We conducted a randomized, controlled clinical trial to assess the safety and efficacy of an absorbable, antibiotic-eluting envelope in reducing the incidence of infection associated with CIED implantations. Patients who were undergoing a CIED pocket revision, generator replacement, or system upgrade or an initial implantation of a cardiac resynchronization therapy defibrillator were randomly assigned, in a 1:1 ratio, to receive the envelope or not. Standard-of-care strategies to prevent infection were used in all patients. The primary end point was infection resulting in system extraction or revision, long-term antibiotic therapy with infection recurrence, or death, within 12 months after the CIED implantation procedure. The secondary end point for safety was procedure-related or system-related complications within 12 months.A total of 6983 patients underwent randomization: 3495 to the envelope group and 3488 to the control group. The primary end point occurred in 25 patients in the envelope group and 42 patients in the control group (12-month Kaplan-Meier estimated event rate, 0.7% and 1.2%, respectively; hazard ratio, 0.60; 95% confidence interval [CI], 0.36 to 0.98; P = 0.04). The safety end point occurred in 201 patients in the envelope group and 236 patients in the control group (12-month Kaplan-Meier estimated event rate, 6.0% and 6.9%, respectively; hazard ratio, 0.87; 95% CI, 0.72 to 1.06; P0.001 for noninferiority). The mean (±SD) duration of follow-up was 20.7±8.5 months. Major CIED-related infections through the entire follow-up period occurred in 32 patients in the envelope group and 51 patients in the control group (hazard ratio, 0.63; 95% CI, 0.40 to 0.98).Adjunctive use of an antibacterial envelope resulted in a significantly lower incidence of major CIED infections than standard-of-care infection-prevention strategies alone, without a higher incidence of complications. (Funded by Medtronic; WRAP-IT ClinicalTrials.gov number, NCT02277990.).

Cardiac electrophysiology study (EPS) and catheter ablation procedure are established diagnostic and therapeutic procedures for cardiac arrhythmias. Pulmonary embolism (PE) is a relatively rare but potentially fatal complication of Cardiac electrophysiology study (EPS). The paradoxical embolism (PDE) occurs due to an intracardiac defect with a right to left shunt with patent foramen ovale (PFO) being the most common cause. The simultaneous occurrence of PE and PDE is rare. Here we present a case of PE and PDE after EPS and radiofrequency catheter ablation (RFCA) of the slow pathway in a patient with recurrent supraventricular tachycardia (SVT) due to atrioventricular nodal reentry tachycardia (AVNRT). To our knowledge, such a case of PE and PDE has not been reported after SVT ablation.

Background: Subcutaneous implantable cardioverter defibrillator (S-ICD) system has been proven to be an effective therapy for prevention of sudden cardiac death (SCD) in selected patients. Although the Shockless IMPLant Evaluation (SIMPLE) trial has shown that defibrillation threshold (DFT) testing is not necessary for transvenous ICD (TV-ICD) systems, it is still recommended for S-ICD systems. We aimed to study the efficacy and safety of S-ICD implantation without DFT in our Heart Center with the comparison of S-ICD patients’ outcome to those with a single chamber TV-ICD without DFT in the same period. Methods: A retrospective analysis of patients underwent S-ICD without DFT from December 2014 to May 2016 with the comparison to single chamber TV-ICD patients implanted during the same period. Results: Thirty consecutive patients (23 males (76.7%); mean age 41 ± 13 years; mean left ventricular ejection fraction 30±12%) received a S-ICD for primary (25 patients, 83.3%) or secondary prevention (five patients, 16.7%) of SCD. During a mean follow-up of 710.6 ± 190 days, three patients received 38 appropriate ICD shocks (90.5%), and two patients received four inappropriate shocks (9.5%). There were two mortalities (6.7%): one cardiac and one non-cardiac. When compared to 30 consecutive who received a single chamber TV-ICD during the same period, there was no significant difference in mortality. Conclusions: Implantation of S-ICD using intermuscular approach without DFT seems to be safe and effective. Data from large S-ICD registries with long-term follow-up, and preferably randomized controlled studies, are needed to confirm this finding. Cardiol Res. 2017;8(6):319-326 doi: https://doi.org/10.14740/cr638w

Background: Heart failure (HF) is a common cardiovascular disease with high rates of morbidity and mortality despite advances in medical and device-related management. Cardiac Contractility Modulation (CCM) is a promising therapy in HF patients with narrow QRS complex and CCM devices are approved and available for clinical use in Europe. On the other hand, there has recently been an increased interest in subcutaneous implantable cardioverter defibrillators (S-ICD) in HF patients with low ejection fraction. S-ICDs obviate the vascular and lead complications associated with conventional ICDs. There are limited data about the combination of CCM and S-ICD in management of HF patients.

Background: Lead insulation failure or lead fracture due to crush injury is one of the potential complications of cardiac implantable electronic device (CIED) implantation. It usually occurs after medial intrathoracic puncture of the subclavian vein and results in damaging of the lead body by entrapment within the costoclavicular ligament and/or the subclavian muscle.We are presenting a case of a pacemaker lead failure due to subclavian crush syndrome that occurred twice, and it led to the acquisition of new pacing lead entry site. Case: A 50-year-old male patient with a history of symptomatic bradycardia due to sick sinus syndrome. He was a manual worker and right-handed. He underwent dual chamber pacemaker implantation initially in the left pectoral area, but it was removed a year later due to infection complicating traumatic hematoma to the pacemaker pocket. He underwent implantation of a new pacemaker system on the right side with leads insertion through a percutaneous right subclavian vein puncture (SVP). He developed right atrial (RA) lead failure about 11 years later due to subclavian crush syndrome. He underwent a new RA lead implantation from the same site. He again had an RA lead malfunction about two years later due to the same mechanism. He eventually underwent a new pacemaker system implantation via the right cephalic vein. Discussion: The cardiac pacing leads are prone to dislodgement, insulation failure, and conductor fracture. Lead fractures are seen with an incidence rate of 0.1 to 4.2% per patientyear. The cephalic vein cut down (CVC) and axillary vein puncture (AVP) approaches show better long-term efficacy and lower lead complication rates than the SVP approach for permanent pacemaker implantation. Conclusion: Subclavian crush syndrome is one of the recognized causes of CIEDs lead failure, and it occurs mostly with SVP. Alternative approaches such as CVC down and AVP have been associated with better outcomes and fewer incidences of subclavian crush syndrome in comparison with the SVP approach.

The development of information communication and technology has brought a new paradigm of education globally and particularly in Indonesia. Face to face learning has some limitations in terms of understanding, space, and time. The general concept of the flipped classroom method is that the students learn the materials at home and do the reinforcement in the classroom as well as learn the materials they yet to understand. The teacher dominates the learning process verbalism and stressful due to the overload materials in time limitation. This leads to teachers’ unawareness of the student's understanding. Therefore, in Industry 4.0, the learning process internet-based become the primary alternative to overcome the gap. Android-based flipped classroom model is one of the chosen solutions in this research to develop the online teaching media and learning materials. The research aimed to compare the effect of the Android-based flipped classroom model against the students' achievement in one of the schools in Jeddah and Indonesia. Research and Development (R&D) adapted from Dick and Carey used in this research. The development of an Android-based flipped classroom model effectively implemented in Indonesia but did not effectively implement in Jeddah. The results showed that the students' achievement for Indonesian students was significantly higher than of Jeddah students. However, both students and teachers in both schools showed a positive response to the Android-based flipped classroom model.

Background: Permanent pacemaker (PPM) implantation after cardiac surgery is required in 0.4-6% of patients depending on cardiac surgery type. PPM implantation in the early postoperative period may reduce morbidity and postoperative hospital stay. We performed a retrospective review of electronic medical records of adult patients with coronary artery bypass grafting (CABG), valve surgery, or both, over a 3-year period. Our aim was to identify predictors of PPM requirements and PPM dependency on follow-up in the current surgical era. Methods: After exclusion of patients with congenital heart disease, patients who already had a PPM or implantable cardioverter defibrillator (ICD), and patients with an indication for PPM or ICD before surgery, we identified 1,234 adult patients who underwent cardiac surgery between January 2007 and December 2009. A retrospective review of electronic medical records and pacemaker clinic data was performed. Results: Patients’ mean age was 46.65 ± 16 years, and 59% were males. CABG was performed in 575 (46.6%) cases, aortic valve replacement in 263 (21.3%), mitral valve replacement in 333 (27%), and tricuspid valve replacement in 76 patients (6.2%). Twenty patients (1.6%) required implantation of a PPM postoperatively. Indications for PPM implantation included complete atrioventricular (AV) block in 13 (65%), sick sinus syndrome in three (15%), and atrial fibrillation (AF) with a slow ventricular rate in four (20%). Predictors for PPM requirement by multivariate analysis were the presence of pulmonary hypertension (P-HTN), reoperation, and left bundle branch block (LBBB) (P < 0.05). Late follow-up was available in 18 patients, at 84.5 ± 30 months. Eleven patients (61%) were PPM dependent on long-term follow-up. Conclusions: Patients at high risk for PPM implantation after cardiac surgery include those with P-HTN, reoperation, and pre-existing LBBB. Of those receiving a PPM, about one-third will recover at least partially at long-term follow-up. We recommend preoperative assessment for risk of requiring postoperative PPM, to counsel patients about this risk and early PPM implantation in high-risk patients who are PPM dependent after surgery. Cardiol Res. 2016;7(4):123-129 doi: http://dx.doi.org/10.14740/cr480w

Background. Reduced heart rate variability (HRV) indicates dominance of the sympathetic system and a state of “physiologic stress.” We postulated that, in patients with critical illness, increases in HRV might signal successful resuscitation and improved prognosis. Methods. We carried out a prospective observational study of HRV on all patients referred to the rapid response team (RRT) and correlated with serial vital signs, lactate clearance, ICU admission, and mortality. Results. Ninety-one patients were studied. Significantly higher HRV was observed in patients who achieved physiological stability and did not need ICU admission: ASDNN 19 versus 34.5, p=0.032; rMSSD 13.5 versus 25, p=0.046; mean VLF 9.4 versus 17, p=0.021; mean LF 5.8 versus 12.4, p=0.018; and mean HF 4.7 versus 10.5, p=0.017. ROC curves confirmed the change in very low frequencies at 2 hours as a strong predictor for ICU admission with an AUC of 0.772 (95% CI 0.633, 0.911, p=0.001) and a cutoff value of −0.65 associated with a sensitivity of 78.6% and a specificity of 61%. Conclusions. Reduced HRV, specifically VLF, appears closely related to greater severity of critical illness, identifies unsuccessful resuscitation, and can be used to identify consultations that need early ICU admission.

Background: The implantable cardioverter-defibrillator (ICD) is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region. Methods: Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates. Results: Fifteen centers in six countries are enrolling patients (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar). Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of ≤150 devices, and pulse generator replacements constitute

Summary Efficient energy consumption is the most important challenge in wireless sensors networks. Many solutions have been proposed since many years as efficient medium access control protocols, smart sensing applications, appropriate task scheduling, and so on. Task scheduling allows could participate to optimise energy consumption, it aims to propose planning over repetitive time periods where sensors need to sleep, to collect data and to communicate. In this paper, we propose two scheduling procedures (semi-dynamic and dynamic) which are executed over the ZigBee network in beacon-enabled mode. Each of these algorithms has its own features and advantages. The Zigbee super-frame is used as a means to inform each node on its duties (when to sleep or when to communicate). In order to evaluate our proposals, we have implemented them over TelosB motes running on operating system TinyOS. These algorithms have been implemented on the Z-Monitor tool [4]. We have compared our scheduling approaches to the usual static scheduling method provided by Zigbee. These evaluations show that our proposals enhance network lifetime and ensure better packet data rate and lower latency. Copyright © 2017 John Wiley & Sons, Ltd.

This study was conducted to investigate the hypothesis that patients using β-blockers will develop hearing loss.A cross-sectional study.A total of 125 patients completed the study. A total of 63 patients were on β-blockers and 62 were not on β-blockers.Carvedilol was significantly associated with hearing loss. Other beta-blockers including metoprolol and atenolol showed no association with hearing loss. Linear multiple regression analysis was run including variables of gender, age, ischaemic heart disease, cardiac failure/dilated cardiomyopathy, frusemide and carvedilol use as predictors for total hearing loss severity at all frequencies. Age and gender, as well as carvedilol, were found to be the only statistically significant predictors for hearing loss severity.Chronic use of carvedilol was associated with significant hearing loss. This may need to be taken into account when prescribing the drug. Further randomised controlled studies with baseline audiometric hearing tests before starting treatment, and periodic follow-up tests, would provide a better assessment of the effect of carvedilol on hearing.

Background Infection of cardiac implantable electronic devices is a serious cardiovascular disease and it is associated with a high mortality. Mycobacterium species may rarely cause cardiac implantable electronic devices infection. Case presentation We are reporting a case of miliary tuberculosis in an Arab patient with dilated cardiomyopathy and a cardiac resynchronization therapy-defibrillator device that was complicated with infection of his cardiac resynchronization therapy-defibrillator device. To our knowledge, this is the third case in the literature with such a presentation and all patients died during the course of treatment. This underscores the importance of early diagnosis and management. We also performed a literature review of reported cases of cardiac implantable electronic devices infection related to Mycobacterium species. Conclusions Cardiac implantable electronic devices infection due to Mycobacterium species is an uncommon but a well-known entity. Early diagnosis and prompt management may result in a better outcome.

Heart failure is a common cardiovascular disease with a high morbidity and mortality despite advances in medical and devicerelated management. Cardiac resynchronization therapy (CRT) which is also known as biventricular pacing has proven to be an effective treatment in heart failure [1-6]. However, CRT is generally recommended for patients in sinus rhythm and prolonged QRS complex (≥ 120 ms) with left bundle branch block (LBBB), or a QRS complex width of ≥ 150 ms in the absence of LBBB [6]. On the other hand, only 30-40% of all heart failure patients show such a prolonged QRS complex [7,8] and therefore the 60-70% of patients who have a normal QRS complex cannot be treated with CRT. Furthermore, around 30% of the patients eligible for CRT treatment do not respond to CRT [7,8].

This is a case of a 60-year-old female with a history of diabetes mellitus, hypertension and right breast carcinoma for which she underwent mastectomy, chemotherapy, and radiation therapy nine years earlier. She presented to the oncology clinic for a routine follow-up, and was only on oral hypoglycemic medications and amlodipine for treatment of hypertension. On physical examination, she had a heart rate of 30 bpm and blood pressure of 184/78 mm Hg. Her physical examination was otherwise unremarkable apart from variable intensity of the first heart sound. An ECG was obtained, and it showed a complete atrioventricular block with a sinus rate of 100 beats per minute, a junctional escape rhythm of 33 bpm and a corrected QT interval of 428 milliseconds. Her ECG seven months earlier was unremarkable. Laboratory investigations including serial cardiac enzymes and thyroid function tests were normal. Echocardiogram showed normal left ventricular systolic function and no significant abnormalities. Cardiac CT scan showed normal coronaries. While awaiting pacemaker implantation, the patient was noted to have episodes of non-sustained polymorphic ventricular tachycardia (VT) followed by sustained VT that degenerated into ventricular fibrillation (VF) (Figure 1). Prompt defibrillation was performed with a biphasic shock of 200 Joules (Figure 2). A temporary pacemaker was inserted and followed by implantation of a dual chamber pacemaker without complications.

In Wireless Sensors Network (WSN) the energy parameter is important. The traffic management needs a clever scheduling algorithm that can balance the energy consumption and the time slots also can be divided according to the traffic pattern. Every sensor node collects the environmental data and sends it to the coordinator. Using scheduling algorithm allows the communication process to be done in a collision-free mode. This work propose two scheduling algorithms called semidynamic and dynamic. They are executed over ZigBee/ IEEE 802.15.4 network. The network coordinator is programmed to organize and synchronize the network based on the proposed algorithms. They are implemented in beacon-enabled mode. The beacon frames are defined only by the network coordinator. The beacon exchanging process between the coordinator and its child routers keep all sensor nodes synchronized. Our work is to use the scheduling algorithm in organizing beacon frames as well as super frames. We have validated our work by implementing the proposed algorithms over TelosB sensors. They are implemented under TinyOS environment.

BACKGROUND AND OBJECTIVES: Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a rare genetic disorder that primarily involves the right ventricle (RV). It is characterized by progressive replacement of RV myocardium by fibrofatty tissues. It commonly presents with ventricular tachycardia (VT) of RV origin and may result in RV failure. The aim of this study is to evaluate the clinical characteristics of adult patients with ARVC/D treated at the Heart Centre, King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia. DESIGN AND SETTINGS: This is a retrospective study of patients with ARVC/D diagnosed and treated at the KFSH&RC Heart Centre in Riyadh. PATIENTS AND METHODS: Twenty-two cases with ARVC/D with regular follow-up at our Heart Centre from January 2007 to May 2010 were included in this study. The diagnosis of ARVC/D was made according to the revised International Task Force Criteria. The clinical data were collected from patients’ charts and electronic medical records. RESULTS: The majority of patients were males (18; 82%). The diagnosis of ARVC/D was definite in 18 patients (82%), borderline in 2 (9%), and possible in 2 (9%). The mean age at diagnosis was 33.3 years. The follow-up period ranged from 29 to 132 months, with a mean follow-up period of 84 months. Ten patients presented with sustained VT, and 3 were survivors of cardiac arrest. Electrocardiogram abnormalities were present in 16/22 patients (72.7%). Echocardiographic changes meeting major diagnostic criteria were seen in 16 patients (76%). Cardiac magnetic resonance imaging was performed in 11 patients, and showed changes compatible with major diagnostic criteria in 7 patients (64%). Implantable cardioverter defibrillators (ICDs) were implanted in 17 patients; 8 had appropriate ICD shocks and 5 had inappropriate ICD shocks. Antitachycardia pacing was effective in terminating most of the VT/ventricular fibrillation episodes. CONCLUSION: ARVC/D is a rare but increasingly recognized heart muscle disease seen in Saudi Arabia and other parts of the world. It is associated with a highly nonspecific presentation. VT of RV origin is a common presentation for this disease. Antiarrhythmic medications and ICD implantation are the main management options.

This paper proposes a dynamic slot scheduling for tasks having different time constraints executed over wireless sensor networks (WSN). These tasks may have different priorities. They are usually repeated periodically. We present an algorithm which is able to provide a dynamic scheduling procedure for all tasks. In the actual version, the scheduling algorithm is executed on the network coordinator which monitor the slot distribution for all nodes. This algorithm is implemented over TelosB nodes.

This paper aims to propose a system architecture for a mobile health-monitoring platform based on a wireless body area network (WBAN). We detail the WBAN features from either hardware and software point of view. The system architecture of this platform is three-tier system. Each tier is detailed. We have designed a flowchart of a use of the WBANs to illustrate the functioning of such platforms. We show the use of this platform in a wide area to detect and to track disease movement in the case of epidemic situation. Indeed, tracking epidemic disease is a very challenging issue. The success of such process could help medical administration to stop diseases quicker than usual. In this study, WBANs deployed over volunteers who agree to carry a light wireless sensor network. Sensors over the body will monitor some health parameters (temperature, pressure, etc) and will run some light classification algorithms to help disease diagnosis. Finally, the WBAN will send aggregated data about the disease to some base stations which collect the results. Our platform will run an on-line disease tracking program and to detect some information about how the disease is propagated.

This paper presents Semi-Dynamic Tree Scheduling Process for Wireless Sensor Networks (WSN). We combined two type of scheduling in this study: the static scheduling for coordinator nodes and the dynamic scheduling for leaf nodes. We consider a cluster tree topology in our study with, one main coordinator (Personal Area Network Coordinator), several children coordinators (Routers) and several end devices (leafs). We implement the scheduling algorithm on the PAN Coordinator. The experimental implementation is done over TelosB sensors under TinyOS environment.

This study presents a dynamic slot assignment for tasks executed over Wireless Body Area Networks. We consider tasks which have timing constraints for their execution. and different priorities. They are usually repeated periodically. In this study we propose an algorithm which is able to provide a dynamic scheduling procedure for all tasks. In the actual version, the scheduling algorithm is executed over the network coordinator. This algorithm is implemented over TelosB nodes composing a Wireless Body Area Network.