Coronary artery ectasia is found in 3 to 8% of patient's undergoing angiography and may sometimes induce acute myocardial infarction. Some articles reported a recurrence of acute coronary syndrome (ACS) in the presence of coronary artery ectasia (CAE). Our study aims to summarize the latest evidence on whether the use of anticoagulant in addition to SAPT/DAPT (single antiplatelet/dual antiplatelet) treating ACS with CAE patients is necessary. Since the trials concerning our objectives were scarce, we pooled case reports/series. We performed a comprehensive search on case reports/series on coronary artery ectasia that presented with acute coronary syndrome published until March 2019. We collected 13 cases from 11 reports. Out of 13 patients, 5 (38.5%) took DAPT only without anticoagulant and 8 (61.5%) took anticoagulant ± DAPT. Three out of five (60%) who took DAPT only, experienced recurrences at 1st and 2nd months' follow-up. The other two (40%) was uneventful at a mean of two months' follow-up. Eight patients who took anticoagulant were uneventful for a mean of 8.4 months. Those who took anticoagulant were at lower risk of experiencing ACS recurrence (p = 0.035). Two of the patients who experienced recurrence became 6 and 12 months free after optimal anticoagulation. The author of this study proposed that anticoagulant must be considered should SAPT/DAPT failed to provide adequate protection to the recurrence of ACS, especially in CAE patients who did not have other obvious stenotic lesions. However, the evidence is weak since this study only pooled case reports/series.
Background
Diagnosis‐to‐ablation time (DTAT) has been postulated to be one of the predictors of atrial fibrillation (AF) recurrence, and it is a “modifiable” risk factor unlike that of many electrocardiographic or echocardiographic parameters. This development may change our consideration for ablation. In this systematic review and meta‐analysis, we aim to analyze the latest evidence on the importance of DTAT and whether they predict the AF recurrence after catheter ablation.
Methods
We performed a comprehensive search on topics that assess diagnosis‐to‐ablation time (DTAT) and AF recurrence from inception up until August 2019 through PubMed, EuropePMC, Cochrane Central Database, and http://ClinicalTrials.gov.
Results
There was a total of 3548 patients from six studies. Longer DTAT was associated with increased risk for AF recurrence in all studies included. Meta‐analysis of these studies showed that DTAT had a hazard ratio (HR) of 1.19 [1.02, 1.39], P = .03; I2: 92% for AF recurrence. Upon sensitivity analysis by removing a study, HR became 1.24 [1.16, 1.32], P < .001; I2: 29%. Meta‐analysis on DTAT time >3 years had HR 1.73 [1.54, 1.93], P < .001; I2: 45% for the recurrence of AF. Upon subgroup analysis of data that compared >6 years to <1 year, the HR was 1.93 [1.62, 2.29], P < .001; I2: 0%.
Conclusion
Longer DTAT time is associated with an increased risk of AF recurrence. Hence, determining management at the earliest possible moment to avoid delay is of utmost importance.
Background
Risk stratification in patients with asymptomatic Brugada Syndrome is challenging, and despite recent advances, there is no clear evidence. The first‐degree atrioventricular block was hypothesized to be a predictor of arrhythmic events. Measurement of the PR interval and diagnosing atrioventricular block from surface ECG is easy, noninvasive, and cost‐effective. We aimed to assess the latest evidence on PR interval or first‐degree atrioventricular block and major arrhythmic events related to Brugada Syndrome.
Methods
We performed a comprehensive search in PubMed for “atrioventricular block” OR “PR interval” and “Brugada syndrome.” We included studies that have a component of PR interval and/or first‐degree atrioventricular block and major arrhythmic events related to Brugada Syndrome including syncope/VT/VF/appropriate ICD shocks/ICD implantation.
Results
We included 1526 subjects from 7 studies. Pooled mean difference of PR interval in 4 studies showed a significant difference [MD 10.77 ms (2.97‐18.57) P = 0.007, moderate‐high heterogeneity I2 = 53% P = 0.08]. On sensitivity analysis by removing a study, it became MD 6.50 ms [1.97‐11.03], P = 0.005, heterogeneity I2 = 0% P = 0.52. Indicating that PR interval was prolonged by small margin. Pooled analysis of the association between a first‐degree atrioventricular block and major arrhythmic events was significant [OR 3.33 (2.02‐5.50) P < 0.001, low heterogeneity I2 = 0% P = 0.57].
Conclusion
First‐degree AV block is associated with more frequent major arrhythmic events in Brugada syndrome patients. PR interval seemed to be prolonged but is yet to be determined whether the PR interval association is still significant if it did not cross the first‐degree AVB threshold.
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