Background: Little is known about the prevalence of ATRIAL THROMBOSIS in ATRIAL flutter undergoing cardioversion of rhythm. Several studies, however, have shown that patients with ATRIAL fibrillation have a high prevalence of ATRIAL THROMBOSIS, strongly associated with increased risk of embolism in ATRIAL fibrillation. Still, the incidence of ATRIAL thrombi in patients with ATRIAL flutter is not well established.Methods: Transesophageal echocardiography was done in 30 consecutive non-anticoagulated patients with a mean age of 48.4 years who were admitted for cardioversion of ATRIAL flutter. Mean left ATRIAL size was 4.3cm and mean ejection fraction was 42%. The mean duration of flutter was more than 48 hours. Left ATRIAL thrombus was seen in 2 patients.Results: Two patients had left ATRIAL THROMBOSIS and both of them had rheumatic mitral stenosis. The other patients were free of THROMBOSIS.Conclusion: This study suggests that ATRIAL thrombus is uncommon in patients with ATRIAL flutter, and there is a low risk of thromboembolism after cardioversion, except in rheumatic mitral stenosis, which itself has a high prevalence of left ATRIAL THROMBOSIS.

Background: The systemic immune-inflammation index (SII) has recently been investigated for cardiovascular diseases. We aimed to evaluate the relationship between SII and left ATRIAL THROMBOSIS (LAT). Methods: This retrospective, case-control study recruited patients with nonvalvular ATRIAL fibrillation (NVAF) who underwent transesophageal echocardiography (TEE) for LAT detection before cardioversion or catheter ablation at a tertiary hospital between 2012 and 2021. Demographic characteristics were obtained from the hospital data system. According to TEE findings, the patients were categorized into LAT (+) and (-) groups. Age, gender, history of chronic diseases, urea, creatinine, albumin, hemogram parameters, the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), SII, the CHADS₂,score, the CHA₂, DS₂,-VASc score, echocardiographic parameters, antiaggregant-anticoagulant use, and nonparoxysmal ATRIAL fibrillation were included and analyzed. Results: The study population consisted of 403 patients, including 228 men (56. 6%), at a mean age of 60. 84±, 12. 26 years. A high white blood cell count (WBC) (OR, 1. 26,95% CI, 1. 05 to 1. 51,P=0. 013), a high SII (OR, 1. 00, 95% CI, 1. 00 to 1. 00,P=0. 003), and a low ejection fraction (OR, 0. 95,95% CI, 0. 90 to 0. 99,P=0. 018) were independent predictors of LAT (+). A spontaneous echo contrast (OR, 2. 43,95% CI, 1. 35 to 4. 39,P=0. 003) was associated with LAT (+). SII values above 693. 6 predicted LAT (+) with 71. 6% sensitivity and 71. 7% specificity (AUC, 0. 77,P<0. 001). The predictiveness of SII was similar to that of NLR (0. 77 vs 0. 74, P=0. 093) but higher than PLR (0. 77 vs 0. 67,P<0. 001) and WBC (0. 77 vs 0. 69,P=0. 031). Conclusion: SII is an independent predictor of LAT in patients with NVAF.

Wilms tumor is the most common renal malignancy in childhood, whereas, it only consists 1% of adult renal tumors. It is much more difficult to diagnose in adults because of large differential diagnosis of adults renal masses. A 16 years old female with nonspecific right flank pain was referred. Computerized tomography (CT) scan revealed a large renal mass occupying the right flank area with IVC and intra-ureteral extension. Biopsy also showed a nonspecific spindle cell carcinoma. She underwent an urgent surgery because of intra ventricular extension of the tumor. Pathological assessment also approved the wilms tumor. Regarding the rarity of this lesion in adults, they are treated with the current protocols which are recommended for children. Therefore, the case was treated with adjuvant chemoradiotherapy as stage 5a and National Wilms Tumor Study (NWTS) protocols. Unfortunately, she had a recurrence in her right lung two years after the surgery which was treated with surgery and chemotherapy. She again had a recurrence four months later which ended up in patient's death due to stopping the treatment.

Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children.Extra medullary leukemia including hepatosplenomegaly, lymphadenopathy, and mediastinal mass are the clinical presentations of T-cell ALL. Pericardial effusion and ATRIAL mass are rare presentations of pediatric leukemia.Case Presentation: We report a 15-year-old girl with T-cell ALL, who presented initially with pericardial effusion and cardiac tamponade and subsequently developed right ATRIAL mass. The mediastinal and right ATRIAL masses were excised by surgical procedure as a treatment strategy for prevention of arrhythmia and sudden death.Conclusion: T-cell ALL can present with pericardial and mediastinal involvement as an initial manifestation.Pericardiocenthesis and systemic anticancer chemotherapy without local chemotherapy should be considered in these cases.

Cardiac THROMBOSIS normally occurs in old Syrian hamsters and according to the research it has a higher incidence rate in females than males. The most frequent site of thrombus formation has been reported to be the left atrium and it usually occurs secondary to degenerative cardiomyopathy and amyloidosis. In this study during a period of 2 years, 22 pet Syrian hamsters aged between 1-3 years-old with signs of cardiovascular disease and referred to the small animal Veterinary Teaching Hospital of University of Tehran were examined in order to evaluate for cardiac diseases as well as ATRIAL THROMBOSIS. During the examinations and observations clinical signs such as lethargy, anorexia, hyperpnoea, reduced daily activity, tachycardia, cyanosis, and vaginal discharge were observed. Based on the clinical sings, the initial diagnosis of cardiac disease was made and for more accurate evaluation of cardiac disease, the cases were referred to the radiology department. For detection of specific signs of cardiac disease echocardiography was performed on all patients. in some cases, sampling of vaginal discharge was taken as well and transferred to the lab for bacterial culture. Cardiac THROMBOSIS and especially ATRIAL THROMBOSIS in all cases were diagnosed by echocardiography so that 9 cases showed pyometra concurrently.

THROMBOSIS is a rare complication of acute lymphoblastic leukemia usually occurring following chemotherapy. The most common reported site is intracranial THROMBOSIS. We reported a case of acute lymphoblastic leukemia with right ATRIAL THROMBOSIS and pulmonary embolism at diagnosis. This diagnosis is important as it can greatly contribute to morbidity and mortality in acute lymphoblastic leukemia patients.

Apixaban was introduced in clinical use for nonvalvular ATRIAL fibrillation as an alternative to warfarin. There is a dearth of information regarding apixaban use in patients suffering from ATRIAL fibrillation with intracardiac foreign bodies such as pacemaker leads. In this report, we describe a 72-year-old female patient with a complaint of weakness in both legs of a few days’ duration. She was detected to have a thrombus over the pacemaker lead and inside the left ATRIAL appendage during apixaban treatment. After the discontinuation of apixaban and the commencement of warfarin, the thrombus was resolved. Our case is the first report to show that apixaban treatment (5 mg, twice daily) may not prevent the development of pacemaker lead THROMBOSIS in patients with ATRIAL fibrillation.

A 72-year-old patient with a history of nonobstructive hypertrophic cardiomyopathy type III and ATRIAL fibrillation of several years’ duration presented to the emergency department with dyspnea at rest (New York Heart Association functional class IV). The patient had been using metoprolol, digoxin, furosemide, and warfarin and had a history of significant variations in the International Normalized Ratio (INR). Physical examinations revealed irregular pulse (80 bpm), pulmonary fine rales in the half lower part of both lungs, and lower extremity edema (2+).

ATRIAL Fibrillation (AF) is one of the most common arrhythmias that expose patients to thromboembolic events and hemodynamic instabilities. These events increase the risk of developing heart failure, myocardial infarction, sudden cardiac death, and dementia that eventually increase the rate of mortality in patients. The use of anticoagulants can prevent the mentioned severe adverse events. Two commonly used oral anticoagulant groups in AF patients are vitamin K antagonists (warfarin) and non-vitamin K oral antagonists (NOACs) that consist of direct factor Xa inhibitors and direct factor IIa inhibitors. Previous research proved the efficacy of both groups in reducing ischemic events in AF patients. In this review article, we were to evaluate and compare the safety and efficacy of these agents in reducing ischemic and thromboembolic events in AF patients with complicated risk factors such as chronic kidney disease, prosthetic heart valve, history of previous intracranial hemorrhage, etc. Finally, the reversal agents of these anticoagulants have been reviewed in case of severe bleeding, intoxication, and the urgent need for emergency surgery.

Background and Aim: Cardiac electrophysiology study (EPS) is the study of the electrical system of the heart. One of the most common methods of treating cardiac arrhythmias is ablation. The main problem with this method is determination of the position of the heart that must be be ablated. Electrocardiogram (ECG) signal is used as a non-invasive, safe and fast tool to understand the electrical activity of the heart. The aim of this study was to identify the focal ATRIAL tachycardia ectopic foci based on ECG signal analysis using sparse decomposition algorithm. Materials and Methods: 12-lead ECG signals of 48 patients with focal ATRIAL tachycardia were recorded and stored. After preprocessing the ECG signals, by using Pan-Tompkins algorithm, each pulse of each signal was separated. Sparse coefficients of test data were calculated based on the sparse decomposition algorithm and the test data were classified. 4 anatomical position in the right atrium, one in the septum and 4 anatomical position in the left atrium were considered as 9 classes and the position of the ectopic foci in each test data was determined. Results: At first, the location of the ectopic foci was identified in the right or left atrium, and then the exact anatomical position in each atrium was estimated. The average accuracy of identifying the position of ectopic foci in 5 runs of algorithm was 81. 27±2. 78. The mean accuracy of identification of ectopic foci was 61. 73% in 4 anatomical position of right atrium, 64. 05% in septum and 65. 16% in 4 anatomical position of left atrium. Conclusion: Based on the findings of the study, the location of the ectopic foci of focal ATRIAL tachycardia can be identified with appropriate accuracy using ECG signal analysis before performing electrophysiological study.