1.Sex‑related differences of fatty acid‑binding protein 4 and leptin levels in atrial fibrillation: an updated review
Shahab SAIDULLAH ; Binish Ayub AHMAD ; Muhammad Saad WAQAS ; Anam FATIMA ; Malik Hasnat ul Hassan KHAN ; Umer KHIYAM ; Jahanzeb MALIK
International Journal of Arrhythmia 2024;25(1):1-
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia affecting millions of individuals worldwide and posing significant challenges to healthcare systems. The growing body of research has uncovered sex-related differences in AF pathophysiology, including the role of fatty acid-binding protein 4 (FABP4) and leptin as potential biomarkers. FABP4 and leptin, key adipokines involved in cardiovascular health, have been linked to inflammation, oxidative stress, and endothelial dysfunction, all of which may contribute to AF development. These adipokines exhibit sex-specific differences in their concentrations, with females generally showing higher FABP4 levels and males displaying distinct leptin profiles. Furthermore, hormonal influences, particularly estrogen, and testosterone, play significant roles in shaping AF risk and atrial remodeling. Estrogen is associated with cardioprotective effects, while testosterone may exert proarrhythmic effects. Understanding these sex-specific mechanisms could lead to more tailored and effective clinical management of AF. The future of AF research holds promise for precision medicine, novel therapeutic targets, artificial intelligence integration, and personalized care approaches. Emphasizing patient-centered care, telemedicine, and multidisciplinary collaboration can further enhance AF management and improve patient outcomes. In conclusion, recognizing and addressing sex-related factors in AF pathophysiology offer opportunities for gender-responsive interventions and advancements in AF management. Implementing these insights may pave the way for targeted therapies and improved quality of life for individuals affected by AF.
2.One‑year outcomes of anterior–posterior vs. anterior‑lateral method of cardioversion for atrial fibrillation: a tertiary center experience
Sarim RASHID ; Syed Ahmed SALAHUDDIN ; Fatima SAJID ; Syed Yasir SHAH ; Jahanzeb MALIK ; Saifullah KHAN
International Journal of Arrhythmia 2024;25(1):3-
This retrospective cohort study aimed to compare the one-year outcomes of anterior–posterior (AP) and anterior— lateral (AL) methods of cardioversion for atrial fibrillation (AF). A total of 2168 patients were included, with 1125 patients in the AP cardioversion group (Group 1) and 1043 patients in the AL cardioversion group (Group 2). Baseline characteristics, primary and secondary outcomes, safety outcomes, and logistic regression predictors of sinus rhythm were analyzed. The results showed comparable rates of maintaining sinus rhythm at the one-year follow-up between the two groups (65.8% in Group 1 vs. 65.7% in Group 2, p = 0.042). There were no significant differences in the incidence of AF recurrence or safety outcomes between the groups. Logistic regression analysis identified the duration of AF and the presence of coronary artery disease as significant predictors of sinus rhythm maintenance. Additionally, the use of the AL method was associated with a higher likelihood of AF recurrence compared to the AP method (p = 0.043). These findings suggest that both the AP and AL methods of cardioversion are effective in achieving and maintaining sinus rhythm in AF patients. The duration of AF and the presence of coronary artery disease should be considered when selecting the cardioversion approach. These results contribute to the understanding of optimal treatment strategies for AF and support personalized management decisions based on individual patient characteristics.
3.Validation of arrhythmogenic right ventricular cardiomyopathy risk calculator for sudden cardiac death: a systematic review
Sarim RASHID ; Ritesh PAHWANI ; Sahil RAJ ; Hafiz Ahmed Raza KHAN ; Saffa NADEEM ; Muhammad Usman GHANI ; Jawad BASIT ; Amin MEHMOODI ; Jahanzeb MALIK
International Journal of Arrhythmia 2023;24(4):25-
In the context of ARVC, a systematic review of the validation of the ARVC risk score can provide insights into the accuracy and reliability of this score in identifying patients at high risk of ARVC. Digital databases were searched to identify the relevant studies using Medical Subject Headings (MeSH). A total of 8 studies were included in this systematic review. A total of 8 studies were included in this review. The review found that the sensitivity of the ARVC risk scores ranged from 80 to 95%, and the specificity ranged from 31 to 79%. The PPV was 55%, and the NPV was 88%. The ARVC score provided a C-index for a 5-year VA risk prediction of 0.84 [95% CI (0.74–0.93)] and a Harrell C-index of 0.70 (95% CI 0.65–0.75). The calibration slope was 1.01 (95% CI 0.99–1.03). ARVC score demonstrated a significant event 5-year threshold between 15 and 20% and the classical ARVC 5-years/freedom-from-VA rate was 0.76(0.66–0.89) and the non-classical form 5-years/freedom-from-VA rate was 0.58 (0.43–0.78). In conclusion, the validation of ARVC risk scores is an essential step toward improving the accuracy of ARVC diagnosis and risk stratification. Further studies are needed to establish the accuracy and reliability of ARVC risk scores and to address the limitations of the current evidence.
4.Role of anticoagulation with apixaban in left‑sided atrial tachycardias
Fraz Ahmed BAIG ; Muhammad Syed ANWAR ; Muhammad Firdous KHAN ; Aroon KUMAR ; F. N. U. MUSKAN ; Jiyanth PARKASH ; Ali KARIM ; Iftikhar AHMED ; Waheed AKHTAR ; Jahanzeb MALIK
International Journal of Arrhythmia 2024;25(2):10-
Background:
Atrial tachycardia poses challenges in patient management due to the associated risks of stroke and systemic embolism. While anticoagulation is recommended in atrial fibrillation (AF), its role in atrial tachycardia remains less defined. This prospective study aimed to evaluate the efficacy and safety of apixaban, a direct oral anticoagulant, in individuals diagnosed with left-sided atrial tachycardias.
Methods:
Patients diagnosed with left-sided atrial tachycardia (n = 439) were observed over 3 years. Baseline characteristics, medication regimens, and clinical outcomes were assessed. Apixaban-treated individuals (n = 213) received standard or reduced dosages, while the control group (n = 226) received standard care. Primary outcomes included stroke, systemic embolism, bleeding, and mortality rates.
Results:
Baseline characteristics were comparable between groups. The apixaban cohort showed a lower incidence of stroke (7.0% vs. 9.3%, p = 0.027) and decreased all-cause mortality (11.7% vs. 12.8%, p = 0.012) compared to controls.No significant differences were found in major bleeding or systemic embolization between groups.
Conclusion
Apixaban demonstrated a potential benefit in reducing stroke and mortality rates in patients with leftsided atrial tachycardia. While requiring further validation, these findings suggest a potential role for apixaban in anticoagulation strategies for atrial tachycardia management.