Papers by Amir Farjam Fazelifar
Journal of Cellular and Molecular Medicine, May 15, 2023
Cardiovascular diseases (CVDs) constitute one of the significant causes of death worldwide. Diffe... more Cardiovascular diseases (CVDs) constitute one of the significant causes of death worldwide. Different pathological states are linked to CVDs, which despite interventions and treatments, still have poor prognoses. The genetic component, as a beneficial tool in the risk stratification of CVD development, plays a role in the pathogenesis of this group of diseases. The emergence of genome‐wide association studies (GWAS) have led to the identification of non‐coding parts associated with cardiovascular traits and disorders. Variants located in functional non‐coding regions, including promoters/enhancers, introns, miRNAs and 5′/3′ UTRs, account for 90% of all identified single‐nucleotide polymorphisms associated with CVDs. Here, for the first time, we conducted a comprehensive review on the reported non‐coding variants for different CVDs, including hypercholesterolemia, cardiomyopathies, congenital heart diseases, thoracic aortic aneurysms/dissections and coronary artery diseases. Additionally, we present the most commonly reported genes involved in each CVD. In total, 1469 non‐coding variants constitute most reports on familial hypercholesterolemia, hypertrophic cardiomyopathy and dilated cardiomyopathy. The application and identification of non‐coding variants are beneficial for the genetic diagnosis and better therapeutic management of CVDs.
Introduction: Dual atrioventricular (AV) node physiology is the substrate for atrioventricular no... more Introduction: Dual atrioventricular (AV) node physiology is the substrate for atrioventricular nodal re-entrant tachycardia but electrophysiological manifestation may be different in this group of patients. Case Presentation: A 44-year-old male known case of coronary artery disease from one year ago presented with frequent palpitation that was refractory to anti-arrhythmic drugs. On surface electrocardiogram (ECG), there was one P wave preceding two up to four consecutive QRS complexes. An electrophysiological study was performed and dual AV node physiology in combination with concealed AV node conduction was confirmed. There was unsuccessful radiofrequency ablation (RFA) application in the right posteroseptal area but in second try, successful RFA application was performed in the left posteroseptal area. Conclusions: Dual ventricular response in dual atrioventricular nodal (AVN) physiology is not the usual presentation and may be misdiagnosed with other rhythm disorders. Considering the typical finding on surface ECG and the exact electrophysiological study, the true diagnosis and management could be done in suspected cases.
Background: Heart block is common among patients with inferior infarction. The aim of this study ... more Background: Heart block is common among patients with inferior infarction. The aim of this study was to evaluate heart block frequency after revascularization therapy in patients with inferior infarction. Methods: One hundred thirty-three patients with inferior wall myocardial infarction (MI) were enrolled in this study and underwent myocardial revascularization therapy (thrombolytic therapy, coronary artery bypass graft, and percutaneous angioplasty). Heart block (based on electrocardiography) was evaluated before revascularization therapy. The relationship between heart block recovery time and treatment type was defined. Results: Twenty-six (19.5) patients were female (mean age=24.6±6.5 years). Fifty-nine (44.4) patients did not have heart block. First, second, and third-degree heart block were seen in 59 (44.4), 4 (3.1), and 11 (8.3) patients, respectively. Heart block recovery during 24 hours after inferior MI was seen in 30.8 in the patients treated by thrombolytic therapy, 50.1 in the patients treated by precutaneous angioplasty, and 11.1 in the patients treated by medical therapy (p value=0.01). Conclusions: Heart block recovery during 24 hours after inferior wall MI was more frequent in the patients treated by percutaneous coronary intervention. Rapid revascularization may cause fast recovery from heart block in patients with inferior MI
Europace, Sep 24, 2009
To predict response to cardiac resynchronization therapy (CRT) in patients with heart failure (HF... more To predict response to cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and intraventricular conduction delay. Methods and results The study population consisted of 82 consecutive HF patients with standard CRT indications. Patients were classified as responders, if they were alive without cardiac decompensation and experienced 15% decrease in left ventricular end-systolic volume. Sixty-eight percent of the enrolled patients responded to CRT. When compared with nonresponders, responders had a wider baseline QRS width (P ¼ 0.001), more marked QRS shortening (DQRS) immediately after CRT (P ¼ 0.001), and a better improvement in aortic velocity time integral (VTI) 24 h after CRT (P ¼ 0.02). Moreover, there was a trend towards a greater baseline intraventricular dyssynchrony in the responder group (P ¼ 0.07). By multivariable logistic regression, the baseline QRS width (OR: 0.95, 95% CI: 0.90-0.97, P ¼ 0.001), DQRS (OR: 1.038, 95% CI: 1.012-1.064, P ¼ 0.003), and acute aortic VTI (OR: 0.81, 95% CI: 0.68-0.96, P ¼ 0.017) emerged as independent predictors of response to CRT. Receiver operating characteristic curve analysis identified a QRS width .145 ms, DQRS .20 ms, and aortic VTI .14 cm to predict responders. Conclusion A positive response to CRT was observed in 68% of the patients. Cardiac resynchronization therapy response is predictable using simple electrocardiographic and echocardiographic data.
International Journal of Cardiology, May 1, 2013
Sodium channel blockers are used to unmask the diagnostic ECG pattern of the Brugada syndrome (Br... more Sodium channel blockers are used to unmask the diagnostic ECG pattern of the Brugada syndrome (BrS) in case of a non-diagnostic baseline ECG. The aim of the study was to determine clinical and ECG predictors of a positive challenge test in patients suspected to the BrS. A total of 106 consecutive patients (91 men; mean age, 35 ± 12 years) suspected of the BrS underwent the intravenous sodium channel blocker challenge test with procainamide or flecainide. Of the 106 patients, positive tests were detected in 20 (19%) patients. During test, a transient episode of a second-degree atrioventricular block and isolated ventricular ectopies were observed in 1 (0.9%) and 2 (1.9%) patients, respectively. A QRS prolongation ≥ 30% was observed in 4 (3.8%) patients. Baseline QRS duration in V1 ≥ 110 ms had a sensitivity of 70% and a specificity of 80% for a positive response. An ST-segment elevation ≥ 0.17 mV in V2 had a sensitivity of 60% and a specificity of 82% for a positive response. Of the multiple clinical and ECG variables entered into a binary logistic regression analysis, a history of syncope (P=0.001), previous cardiac arrest (P=0.001), baseline QRS duration in V1 ≥ 110 ms (P=0.001), and baseline ST-segment elevation in V2 ≥ 0.17 mV (P=0.012) emerged as the independent predictors of a positive response to the intravenous challenge with sodium channel blockers. The results of the sodium channel blocker challenge test can be predicted by clinical presentation and baseline ECG features.
Cardiovascular Pathology, Dec 23, 2019
Congenital absence of left atrial appendage (LAA) is an extremely rare condition and is usually d... more Congenital absence of left atrial appendage (LAA) is an extremely rare condition and is usually diagnosed incidentally in imaging intended for other purposes. Herein, we report a rare case of absent left atrial appendage in an 80-year-old gentleman who was candidate for radiofrequency catheter ablation procedure for atrial flutter rhythm in whom we observed the absence of left atrial appendage in echocardiographic examination. Computed tomography angiographic examination performed in the evaluation course of the patient was also confirmative of this finding. As there is no data on anticoagulating of patients with absent left atrial appendage, after successful radiofrequency catheter ablation procedure, we continued rivaroxaban per guidelines. The results of a second imaging modality and a thorough medical history are critical for diagnosis of absent left atrial appendage. These steps are required to rule out imitating conditions such as prior surgical/percutaneous exclusion, unusual anatomical features or flush thrombotic exclusion of left atrial appendage. In this case report, we also provide a brief review of the characteristics of 17 cases that have been reported in the literature so far.
Journal of Arrhythmia, Apr 21, 2023
BackgroundLong QT syndrome (LQTS) is a lethal cardiac condition. However, the clinical implementa... more BackgroundLong QT syndrome (LQTS) is a lethal cardiac condition. However, the clinical implementation of genetic testing has now made LQTS eminently treatable. Next‐generation sequencing has remarkable potential for both clinical diagnostics and research of LQTS. Here, we investigated the genetic etiology in an LQTS‐suspected Iranian pedigree by whole‐exome sequencing and collected all KCNH2 variants with consensus based on publications.MethodsWES was performed on the proband of this pedigree to reveal the underlying cause of sudden cardiac death (SCD). The variant found was validated and segregated by polymerase chain reaction and Sanger sequencing. Based on the literature review, KCNH2 variants were retrospectively analyzed to identify pathogenic variants, likely pathogenic variants, and variants of uncertain significance by using different prediction tools.ResultsWES identified an autosomal dominant nonsense variant, c.1425C>A: p.Tyr475Ter, in the KCNH2 gene, which appeared to be the most likely cause of LQTS in this pedigree. Moreover, our comprehensive literature review yielded 511 KCNH2 variants in association with the LQTS phenotype, with c.3002G>A (CADD Phred=49) being the most pathogenic variant.ConclusionsVariants in the KCNH2 gene are considered a major cause of LQTS worldwide. The detected c.1425C>A is a novel variant to be reported from Iran for the first time. This result indicates the importance of KCNH2 screening in a pedigree with SCD cases.
Research in Cardiovascular Medicine, 2018
The increasing number of complex functions in implantable devices demands for an increased abilit... more The increasing number of complex functions in implantable devices demands for an increased ability to recognize these features during patient monitoring and assessment. New device algorithm and lead structures are embryonic concerning device implantation; hence, we should familiarize ourselves and become alert of different types of device malfunction. Although it is unreasonable to expect to know the exact details of all algorithms, the numerous most often encountered should be discussed. This case highlights a novel device malfunction and its management in a 76-year-old male after coronary artery bypass grafts.
Background: Epicardial pacemakers are known as an alternative for endocardial pacemakers in some ... more Background: Epicardial pacemakers are known as an alternative for endocardial pacemakers in some cases such as heart block, and complex congenital heart diseases. Considering recent advances and improvement of epicardial lead subtypes, it is essential to investigate the long-term function of them. In this study, we aimed to assess the sensing and pacing characteristics, and survival of bipolar steroid-eluting and unipolar non-steroid-eluting epicardial pacemakers. Methods: We conducted an entirely concentrated search on the documents of all patients who had undergone epicardial lead implantation in the Shaheed Rajaie Cardiovascular, Medical & Research Center during 2015-2018. Implant, and follow up data were extracted. Kaplan Meier analysis and Weibull regression hazards model were applied for the survival analysis. Results: eighty-nine leads were implanted for 77 patients. Of the total leads, 52.81%, 53.93%, and 47.19% were implanted in children (under-18-year-old), females, and pa...
Radiographic Atlas of Cardiac Implantable Electronic Devices, 2022
Radiographic Atlas of Cardiac Implantable Electronic Devices, 2022
Tłumaczenie: Agnieszka Syska Wpływ przedoperacyjnego stosowania kwasu acetylosalicylowego na wyst... more Tłumaczenie: Agnieszka Syska Wpływ przedoperacyjnego stosowania kwasu acetylosalicylowego na występowanie krwawienia pooperacyjnego i okołooperacyjnego zawału serca u osób poddawanych pomostowaniu aortalno-wieńcowemu Streszczenie Wstęp: Podjęto próbę oceny wyników klinicznych (śmiertelność, występowanie krwawienia pooperacyjnego i okołooperacyjnego zawału serca) u pacjentów, których poddano pierwszej operacji pomostowania aortalno-wieńcowego, otrzymujących w okresie przedoperacyjnym kwas acetylosalicylowy. Metoda: Do prospektywnego, randomizowanego badania przeprowadzonego metodą ślepej próby włączono 200 pacjentów, których podzielono na dwie grupy. Osoby z jednej z nich otrzymywały kwas acetylosalicylowy w dawce 80-160 mg, natomiast chorzy z drugiej grupy przyjmowanie tego leku zakończyli przynajmniej 7 dni przed operacją. Pierwotnymi punktami końcowymi badania były: zgon w trakcie hospitalizacji i powikłania związane z krwawieniem (pooperacyjna utrata krwi na oddziale intensywnej ...
Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failur... more Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failure and prolonged QRS duration
Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator im... more Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator implantation: a contrast venographic study on 100 patients admitted for
An electrophysiology study could diagnose and treat many types of cardiac rhythm disturbances. Ca... more An electrophysiology study could diagnose and treat many types of cardiac rhythm disturbances. Cardiac surgery prolonged life in many patients with ischemic and congenital heart disease. Arrhythmia ablation, besides antiarrhythmic drugs and cardiac electronic devices, could improve the quality of life in symptomatic patients. Arrhythmology and interpretation of intracardiac electrophysiology tracing are important steps to understand the mechanism of many effective curative procedures in cardiology.
Background: Congenital heart disease (CHD) is the most common anomaly of the birth defects with a... more Background: Congenital heart disease (CHD) is the most common anomaly of the birth defects with an incidence rate of 8 cases per 1000 live births. As more progression in the surgery of congenital heart disease occurs, the number of patients with CHD is growing. Dierent types of tachyarrhythmias are the consequences of congenital defects (repaired or unrepaired). At birth, these arrhythmias are rarely seen in patients and are associated with myocardial fibrosis and hypertrophy. Objectives: In the present retrospective cross-sectional study, we investigate the prevalence of dierent forms of tachyarrhythmia in CHD patients and acute success rate of catheter ablation in these patients. PatientsandMethods: In this cross-sectional study 196 patients were enrolled. The data were derived from ablation sheets available at the EP center of our tertiary care center between 2001 and 2014. The age, gender, type of CHD, arrhythmia diagnosis and acute success rate of the procedure, as study variab...
Background: Premature ventricular contractions (PVCs) can originate from coronary cusps or epicar... more Background: Premature ventricular contractions (PVCs) can originate from coronary cusps or epicardial surface of the left ventricular outflow tract (LVOT) away from the left coronary cusp. Objectives: The current study aimed to evaluate electrocardiographic features of PVCs originating from two adjacent anatomical areas in the left coronary cusp and great cardiac vein. Methods: Eighty-seven patients with idiopathic premature ventricular contractions (PVCs) or ventricular tachycardia (VT) were enrolled into the study. All patients with highly symptomatic PVCs, high count (> 10000 PVC/24 hours) and/or the left ventricular dysfunction were included in the study. Radiofrequency ablation (RFA) with irrigated tip catheter was performed at the site of earliest activation in the left coronary cusp or great cardiac vein. Results: The study population included 87 patients with frequent PVCs with the mean age of 50 ± 15.17 years including 40 (46%) females; 39 (44.8%) patients had PVC with o...
Research in Cardiovascular Medicine, 2020
Background and Aim: “Idiopathic” ventricular arrhythmias most often arise from the right ventricu... more Background and Aim: “Idiopathic” ventricular arrhythmias most often arise from the right ventricular outflow tract (RVOT), although arrhythmias from the left ventricular outflow tract (LVOT) have also been observed. The aim of the study was to investigate the importance of signal of great cardiac vein (GCV) to distinguish premature ventricular contraction (PVC) originated from LVOT and PVC originated from RVOT. Materials and Methods: A coronary sinus catheter was placed in the GCV under fluoroscopy to measure the distance of GCV signal to the onset of QRS on surface electrocardiogram (ECG). Catheter ablation was performed utilizing radiofrequency energy in 31 patients. A 12-lead ECG was recorded during PVC. Successful ablation was defined as the complete disappearance of target PVC with no recurrence during the follow-up. Results: Thirty-one consecutive patients (16 male [51.6%]) were enrolled. Overall, 67.7% of the cases had PVC originated from the LVOT and 32.3% from the RVOT. Out of 48.4% of the females, 33.3% had PVC originated from the RVOT and 66.7% from the LVOT (P = 1). The mean ejection fraction regarding PVC originated from the LVOT and RVOT was 47.50 ± 8.95 and 45.50 ± 8.51, respectively (P = 0.7). The distance of GCV signal to the onset of QRS on surface ECG for LVOT- and RVOT-originated PVC was 15.38 ± 25.28 and −29.70 ± 25.66, respectively (P < 0.01). Conclusions: The differentiation between PVC originated from LVOT and RVOT is not entirely utilized through ECG criteria, thus the origin of PVC arising from RVOT/LVOT can be localized using the GCV signals.
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Papers by Amir Farjam Fazelifar