Background: Considering the and importance of formation of atrial Thrombus (AT) in patients who had developed atrial fibrilation (AF) and its early diagnosis, and with some regards to several reports on benefits of applying the D-Dimer test in such conditions, this study was carried out to detemine the accuracy and value of this test compared to the gold standard method of Trans-Esophageal Echocardiography (TEE) in patients referring to Modarres hospital. Materials and Methods: This clinical trial was performed on 73 patients whom were diagnosed as having AF. A more accurate method of TEE was applied to confirm if they had atrial thrombi. For determination of value of D-Dimer test in diagnosis of AT, 5ccof blood was taken from any subjects. The results were regarded normal if the D-Dimer level was less than 500 ng/ml. Then positive and negative predictive values (PPV & NPV) were calculated as diagnostic measurements. Results: Of the 73 subjects of this study (67% women versus 33% men) with mean age of 44.7±12 years old, there was 53.4% who had the history of Warfarin usage. According to the results of D-Dimer test, 33% had reached to positive levels, whereas 67% revealed to have no thrombus. The PPV of this test was calculated 48.6% and the NPV was 81.6%. Conclusion: Regarding the present condition of our patients and the excessive use of Warfarin among them and also probable failures of D-Dimer test, this test does not have the acceptible capability (particularly duringin these situations) in diagnosing AT.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia characterized by irregular heartbeats, often without noticeable symptoms in patients. Diagnosing AF is challenging for cardiologists, requiring advanced methods for accurate identification using electrocardiogram (ECG) signals. Automated AF diagnosis can significantly aid cardiologists in prompt identification, potentially reducing the risks associated with acute heart disease and stroke. Various non-invasive techniques based on ECG signal processing have been suggested to better understand the mechanisms by analyzing the atrial fibrillatory waves (f-waves). Different signal processing methods for f-wave extraction have been explored, which may be classified as follows: average beat subtraction and its advanced variants, QT-interval interpolation, principal and independent component analysis, nonlinear adaptive filtering using an echo state network, diffusion geometry, and extended Kalman filtering. This study aims to extract the f-wave from the ECG signal using the PiCA-ESN algorithm, which yields better results compared to other methods. Additionally, the f-wave's time-frequency behavior was analyzed using the Stockwell transform to differentiate between terminated and non-terminated AF states for the first time in this study. First, the PiCA-ESN algorithm facilitated the extraction of the f-wave from the ECG signal. Subsequently, the Stockwell transform was used to compute the time-frequency maps of the extracted f-wave. Various features were derived from the amplitude of the Stockwell transform and utilized in conjunction with three classifiers: MLP, SVM, and AdaBoost. The findings reveal that the proposed method outperforms selected methodologies from the Physionet Challenge 2004, achieving an impressive 100% accuracy in both tasks. Additionally, an experiment was conducted to assess the robustness of the proposed features across consecutive signal segments, validating their stability during signal analysis.

According to the statistics issued by Iranian Ministry of Health and Medical Education, the most common causes of mortality are Cardiovascular Diseases among which acute myocardial infarction (AMI), bears the maximum rate. Patients involved with AMI and physical disability occupy a large number of hospital beds they are the focal attention of this survey. This study is carried out to determine the major causes of supraventricular tachycardia (SVT) that will help us take right measurements to control SVT. TO do this all patients with SVT leading AMI, their sex and age at the CCU ward of Dr. ALi Shariati Hospital and Noor Hospital during the year 1375 were taken into consideration. In addition, the lacks of old myocardial infarction and hypertension resulted by acute heart attack without SVT complications and left ventricular function were compared on the basis of echocardiography. The patient's mean age was 62.4 years old and the maximum rate of SVT events after AMI was in the seventh decade of their lifetime. The most patients (50%) were involved with anterio rwall M.I 76% of them (38 patients) were involved with atrial fibrillation, 10% of them (5 patients) were involved with aterial flutter and 14% of them (7 patients) were involved with paroxismal supraventricular tachycardia in a comparison between two groups of patients involved with left ventricular ejection fraction (LVEF), with and without SVT complication, EF in patients with SVT was lower than the other group. So that 36% patients with SVT had low LVEF while this proportion was only 4% in the other group. We conclude that the best procedure in SVT treatment is eliminating the underlying factors. Therefore drug therapy or revascularization for left ventricular function is recommended improving.

Background and Aim: based on various studies, GRE (gradient echo)(3 TESLA) can detect pneumobra and also shows the association of SVS with cardiac origin in GRE t2*(according totransesophageal echo), so we intend to consider the ability of GRE with 1. 5 Tesla in the detection of pneumobra and also the association of SVS(susceptibility vessel sign ) with atrial fibrilation For the first time, so, we evaluated the association of SVS with atrial fibrillation in patients with stroke who have been referred within 72 hours. Materials and Methods: The statistical population consisted of 20 patients over the age of 18 years who referred to Valiasr Hospital in Zanjan with cva diagnosis, based on the absence of bleeding in BRAIN CT, different MRI sequences Waere done for them. Due to the fact that this study was a pilot study, sampling method was in available sampling. Information from various BRAIN MRI sequences including DWI (diffusion-weighted imaging )/ GRE T2 * / ADC(apparent diffusion coefficient)/ T1 / T2 / FLAIR(Fluid-attenuated inversion recovery), presence or absence of atrial fibrilation and NIHSS( National Institutes of Health Stroke Scale)items were collected from clinical examination and ekg, and inserted to special chart for statistical analysis. Results: A total of 20 patients with ischemic stroke were enrolled in this study, the mean of the infarction area was DWI = 65ml and the mean NIHSS = 9. GRE T2 *, 50% of patients with SVS and 50% had no SVS. Of the 20 patients, 35% had AF and 65% had not AF in the EKG. Of the 20 patients, 35% had subcortical lesions and 65% had cortical lesion in the DWI sequence. GRET2 * / DWI MATCH was seen in all 13 patients (65%) with cortical lesion in DWI and out of 7 patients (35%) who had DWI in subcortical lesion only In one patient, DWI / GR E T2 * MISMATCH was observed and there was no DWI / GRE T2 * MATCH or MISMACHT in 6 patients. There was no significant relationship between age and SVS and between gender and SVSand between AF and SVS. there was a significant relationship between SVS and infarct area in DWI, between SVS and NIHSS, between cortical lesion in DWI and SVS., between the presence of subcortical infarction region in DWI and the absence of SVS and between the presence of RMHV and SVS. Conclusion: Totally, there was a significant relationship between SVS and infarct volume in DWI and between SVS and NIHSS with p value = 0. 001, also with p value = 0. 003, there was a significant relationship between the presence of cortical infarction in DWI and the SVS sign, subcortical infarction area in the DWI and the absence of SVS and between the presence of RMHV and the SVS sign. With pvalue = 0. 057, there was no significant relationship between atrial fibrilation and SVS. However, due to the low power level of the study (67%), it is recommended that this study be repeated with higher volume, which seems to be significantrelationship between these, with increasing number of samples, and therefore probably In the presence of SVS sign in the GRE T2 sequence, the cause of stroke may be higher in the cardiac region, especially atrial fibrillation. Therefore, patients who have SVS symptoms but do not have atrial fibrillation in the ECG, are candidates for Holter monitoring.

BACKGROUND: Atrial fibrillation (AF) occurs often in patients after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality. The purpose of this study is to compare the prophylactic effect of Amiodarone versus Propranolol in patients with various levels of ejection fraction.METHODS: In this prospective, double-blinded, clinical trial, randomized study, 110 patients received either Amiodarone (n=65) or propanolol (n=65). Adult patients of either sex and age of 40-75 years were considered for participation when listed for nonemergent CABG surgery and bypass without other concomitant procedures. Amiodarone was given as 150 mg single dose 30 min after procedure through 48 hours. In addition, Amiodarone was also administered intravenously during surgery in a 300-mg bolus for 1 h and as a total maintenance dose of 20 mg/kg weight over 24 h on the first day following surgery. Propanolol was given as 10 mg oral single dose immediately after surgery and continued for long term operation. RESULTS: The primary endpoint was the occurrence of AF after CABG. The secondary endpoint was the hospitalization length of stay after CABG. The baseline characteristics were similar in both treatment groups. The incidence of post-operative AF was significantly higher in the Propranolol group compared with the Amiodarone group (4 vs 12.2 % of patients with low EF, P<0.0001). The durations of postoperative intensive care unit stays were the same in the Amiodarone and Propranolol groups (2±0.7 vs. 3.5±0. 5 days, P=0.001). CONCLUSION: This study demonstrates that postoperative course of Amiodarone administration is an effective, possibly safe, well-tolerated, and widely applicable therapy for the prevention of postoperative atrial tachyarrhythmia after cardiac surgery. This benefit was associated with a reduction in the probability of preoperative sustained ventricular tachyarrhythmia and a trend toward a reduction in postoperative hospital stay.

Background and purpose: Preliminary studies have been established to examine the cardiotonic effect of Citrus bigaradia extract, by implenenting various mechanisms. The functional protective role of this plant against supraventricular tachyarrhythmia remains to be determined. The present study is designed to assess the role of hydroalcoholic extract of Citrus bigaradia by modifying the electrophysiological properties of atrioventricular node, during simulated experimental atrial fibrillation in rabbits and also, to determine the role of adrenoceptores regarding effects of Citrus bigaradia on the AV node.Materials and methods: In this present study, Newsland male rabbits (1.5-2kg) were used. Programmed stimulation protocols (Recovery, Wenckbach, Atrial fibrilation and Zone of concealment) were applied in two groups (N=23) to assess electrophysiological properties of isolated rabbit AV node. In the first group (N=10), different concentrations of hydroalcoholic extract of Citrus bigaradia were added to thyrods to detect nodal concealed conduction. In the second group (N=13), the effects of extracts (54-108mg/L) were analysied in the presence of b-adereceptor blocker (Nadolol 2mm). AF protocol was simulated by high-rate atrial pacing with random coupling intervals (range 75-125ms). All data have been shown as Mean ± SE. Results: Citrus bigaradia, had biphasic concentration-effect pattern, such as in low and intermediate concentrations (0.8-3.2mg/L), shortened nodal functional refractory period and Wenckebach. We observed a non-significant decrease in the average H-H intervals and numbers of concealed beats in all concentrations of Citrus bigaradia. Zone of concealment was shortened by this plant. Nadolol (2mm) prevented the whole effects of Citrus bigaradia on the nodal conduction time, refractoriness and concealed conduction.Conclusion: The above results indicate the potential pro-arrhythmic effects of Citrus bigaradia in worsing supraventricular tachyarrhythmia. The effects of plant to decrease the AV-nodal refractory period and concealment zone may be considered the major mechanism of this plant. At least some parts of effects of Citrus is mediated through b-adrenoceptores.

Background: Coronary artery disease (CAD) is among the most common life-threatening cardiovascular diseases, in which blood supply to the heart muscles is reduced or completely blocked. Coronary artery disease has various treatment options, one of which is PCI (Percutaneous Coronary Intervention) or stent placement via angioplasty. Dabigatran etexilate is the only orally available direct thrombin inhibitor, which is actually a prodrug that is rapidly converted to its active form and absorbed through the gastrointestinal tract. The purpose of this study is to compare mortality in patients with Atrial Fibrillation (AF) with a history of Percutaneous coronary intervention (PCI) treated with a low dose (110 mg). In contrast, it was treated with a high dose (150 mg). Methods: The present study was a systematic review and meta-analysis on 4 online databases PubMed, Scopus, Web of Science and EMBASE to find articles that the rate of long-term complications related to bleeding or Thrombotic events were performed in AF patients who underwent PCI and were treated with dabigatran. STATA software was used for data analysis. Results: Nine RCTs or prospective studies with 5694 participants were included. The studies showed that when comparing dabigatran (110 and 150 mg) with warfarin (with/without dual antiplatelet), dabigatran 110 mg was associated with a significant reduction in major bleeding (OR=0. 46, 95% CI: 0. 24-0. 86, P=0. 01), while the 150 mg dose was not statistically different (OR=0. 12, 95% CI: 0. 01-1. 32, P=0. 08). Also, comparing dabigatran 150 with 110 mg showed a higher risk of bleeding at the higher dose (OR=0. 77, 95% CI: 0. 64-0. 92, P<0. 001). On the other hand, dabigatran 110 mg was associated with a significant increase in mortality (OR=1. 33, P=0. 01) and myocardial infarction (OR=1. 61, P=0. 01) compared with combination therapy of warfarin and antiplatelet, but the 150 mg dose did not show a statistical difference. Heterogeneity was high in some analyses (I2 up to 99. 49%), but funnel plots and Egger's test rejected publication bias. Conclusion: There seems to be strong evidence that bleeding complications in dabigatran are less than old antiplatelet and anticoagulation drugs, but in terms of efficacy in reducing mortality, although we did not obtain strong evidence for analysis, older drugs are more effective in preventing death from any cause.