Up to 20% of patients with chronic kidney disease have atrial fibrillation, and 40%-50% of atrial fibrillation patients suffer from chronic kidney disease. The 2 diseases share several risk factors and frequently coincide with each other. Both entities are associated with a prothrombotic state, which contributes to increased thromboembolic risk. Atrial fibrillation patients with chronic kidney disease have elevated risk of stroke, major bleeding, and mortality. Clinical risk scores, including CHA2DS2-VASc score, HAS-BLED score, or ORBIT score have a limited value in adverse clinical outcome risk stratification in patients with severe chronic kidney disease. However, the inclusion of renal function in
the R(2)-CHA2DS2-VASc score does not improve significantly thromboembolic risk prediction in atrial fibrillation. There is growing evidence suggesting that biomarkers, including N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin, cystatin C, or growth differentiation factor-15, might be helpful in the assessment of thromboembolic, bleeding, and/or mortality risk in atrial fibrillation patients with chronic kidney disease. The first-choice anticoagulant therapy is based on direct oral anticoagulants in this subgroup. The highest risk of adverse events is observed in end-stage renal disease, and in Europe, in contrast to the USA, solely warfarin is recommended in such atrial fibrillation patients. Treatment of atrial fibrillation patients with chronic kidney disease should be closely monitored with the selection of right anticoagulant agents at the appropriate dose. The current review paper summarizes available evidence and the challenges of the management of atrial fibrillation patients with chronic kidney disease with practical implications.

Background: The aim of this study was to perform a validity analysis of the Turkish version of the Catheterization Risk Score for Pediatrics.

Methods: The study sample consisted of 419 pediatric patients who underwent cardiac catheterization. Patient risk factors and outcomes were collected using the revised (r) Catheterization Risk Score for Pediatric score (21 points) and Catheterization Risk Score for Pediatric score-20 point (Nykanen score). The serious adverse events and non-serious adverse event complications that occurred during and after the procedure were recorded. The revised Catheterization Risk Score for Pediatrics and Catheterization Risk Score for Pediatrics score-20 points were administered by pediatric cardiologists. The content validity index was calculated based on expert opinions. Chi-square, correlation, and regression analyses were used.

Results: The mean age of the pediatric patients was 4.5 ± 4.8 years. Of the patients, 50.1% were male (n = 210) and 85% (n = 356) had acyanotic heart disease. The patients’ Catheterization Risk Score for Pediatrics score-20 point and revised Catheterization Risk
Score for Pediatrics score were 5.9 ± 2.5 (range, 3-16) and 4.0 ± 2.5 (range, 0-16), respec-tively. Serious adverse events developed in 10.7% (n = 45) of the patients and were found to be related with patient status/timing of catheterization, age, weight, respiratory status, and American Society of Anesthesiologist scores (P <.05). Significant positive cor-relations were found between the incidence of serious adverse events and total revised Catheterization Risk Score for Pediatrics score (21 points), total Catheterization Risk Score for Pediatrics score-20 point, and American Society of Anesthesiologist score (P <.01).

Conclusion: The revised Catheterization Risk Score for Pediatrics score (21 points) and Catheterization Risk Score for Pediatrics score-20 point are valid tools for predicting pre-procedural risk in the Turkish population.

Background: In this study, we aimed to compare the femoral route and the carotid artery route in terms of procedural success of ductal stent implantation in patients with duct-dependent pulmonary blood flow.

Methods: The study included 51 patients with duct-dependent pulmonary circulation who underwent ductal stent implantation upon their admission to our clinic between July 2017 and March 2021. In total, 23 patients (group I) underwent ductal stent implantation via the femoral route, while the remaining 28 (group II) underwent the procedure via the carotid artery. The groups were compared in terms of procedural success, time, post-procedural blood pH, lactate levels, and complications.

Results: Duct morphology was observed in group 1 as follows: type 1 in 12 patients, type 3 in 8, type 2 in 2, and type 6 in 1 patient. In group 2, 26 patients had type 3, 1 had type 2, and 1 had type 6. The tortuosity index of the patients in group 1 was 1 in 8 patients, 2 in 8 patients, and 3 in 7 patients, while in group 2, it was 1 in 5 patients, 2 in 15 patients, and 3 in 8 patients. The success rate was 69.6% (16/26) in group I and 93.5% (29/31) in group II (P =.030). The cumulative success rate was 88.2% (45/51). The procedural durations were 78.2 ± 34.1 and 52.1 ± 22.0 minutes in group I and group II, respectively (P =.002). The mean blood pH values upon the completion of the procedure were 7.26 ± 0.1 and 7.33 ± 0.0 in group I and group II, respectively (P =.038). The mean post-procedural lactate levels were 2.8 mmol/L and 2.3 mmol/L in group I and group II, respectively (P =.038). The 2 groups did not show any differences in terms of procedural complications.

Conclusion: The carotid artery route can be preferred, especially in vertical and tortuous ductus arteriosus, as it is associated with a high success rate and a short procedural time, as well as a better metabolic condition after the procedure.

Background: In this study, we aimed to evaluate the clinical aspects, electrophysiological studies, and ablation results of permanent junctional reciprocating tachycardia in children.

Methods: The study comprised 29 pediatric patients diagnosed with permanent junctional reciprocating tachycardia between 2011 and 2021 in 2 pediatric electrophysiology centers. From the file records, the basic demographic characteristics of the patients, as well as electrocardiographic and echocardiographic findings, were acquired retrospectively. The medical treatment and responses of the patients throughout follow-up, as well as the electrophysiological study and ablation data of the patients who had electro-physiological study, were assessed.

Results: The mean age at diagnosis of the patients was 3.13 ± 4.43 (0-18) years and the
mean weight was 18.22 ± 19.68 (3.8-94) kg. Eighteen patients (62.1%) were girls. Eleven patients (38%) developed tachycardia-induced cardiomyopathy. Tachycardia was incessant in 15 patients (51.7%). In total, 22 patients required 26 ablation procedures. Tachycardia-induced cardiomyopathy and multidrug-resistant tachycardia were the most prevalent indications for ablation. The right posteroseptal pathway was detected in 18 patients (81.8%). The acute procedure success rate was 100% (22/22). The recurrence rate was 18% (4/22) and 3 of them underwent successful ablation again. The overall success percentage was 95.4% (21/22). None of the patients had any complications. The
mean follow-up period was 4.39 ± 3.05 years.

Conclusion: Although permanent junctional reciprocating tachycardia is uncommon, it is often persistent, resistant to medical treatment, and associated with a substantial risk of tachycardia-induced cardiomyopathy. Catheter ablation can be performed on these patients at any age, with minimal risk of complications and a high success rate. It is crucial to keep monitor of the patients’ recurrence.

Background: Several previous studies have suggested that sublethal doses of Escherichia coli lipopolysaccharide (endotoxin) and monophosphoryl lipid A Re595, a non-pyrogenic derivative of Salmonella minnesota lipopolysaccharide, exhibit antiarrhythmic effects in the rat model of ischemia–reperfusion arrhythmias.

Methods: In this study, the protective effect of lipopolysaccharide derivatives was also further investigated in drug (aconitine or ouabain)-induced arrhythmia models, and conclusions were drawn with particular emphasis on the molecular characteristics of different types of lipopolysaccharide.

Results: The importance of the molecular structure for the antiarrhythmic effect of mono-phosphoryl lipid A and E. coli lipopolysaccharide was tested in the ischemia–reperfusion arrhythmia model. In contrast to monophosphoryl lipid A from Salmonella typhimurium SL 684 which has only monophosphoryl residue in its structure, monophosphoryl lipid A Re595, obtained from S. minnesota, and E. coli lipopolysaccharide which have both mono and diphosphoryl residue reduced the duration of ventricular tachycardia (e.g., during reperfusion: vehicle: 176 ± 22.8; monophosphoryl lipid A Re595: 132.83 ± 12.1, as second, n = 8-10, P <.05) and the incidence of ventricular fibrillation. The antiarrhythmic effects of E. coli lipopolysaccharide and monophosphoryl lipid A Re595 in ischemia–reperfusion arrhythmia model were absent in either aconitine- (e.g., onset time for ventricular ectopic beats: saline 25.3 5.0, E. coli lipopolysaccharide 24.3 ± 7.1; vehicle: 24.0 ± 4.5, monophosphoryl lipid A SL684 23.8 ± 4.3, as second, n = 6, P >.05) or ouabain-induced arrhythmia models in mice.

Conclusion: Therefore, we conclude that lipopolysaccharide derivatives exhibit anti-arrhythmic effect only in ischemia–reperfusion arrhythmias, and lipopolysaccharide should possess diphosphoryl groups in its subcomponent composition for this antiar-rhythmic effect.

Background: We aimed to evaluate the feasibility and performance of myocardial work echocardiography in assessing the severity of acute stroke and neurological deficits in patients with acute ischemic stroke.

Methods: A total of 176 patients were examined by echocardiography within 24-48 hours of symptom onset with the measurement of global and regional myocardial work. The National Institutes of Health Stroke Scale score of each patient was documented.

Results: With the increase of the National Institutes of Health Stroke Scale score, myocardial constructive work or positive work decreased (P <.05), while myocardial wasted work or negative work increased (P <.05). Except for global constructive work, global positive work, and global systolic constructive work, other myocardial work parameters all correlated with the National Institutes of Health Stroke Scale score
(P  < .05). Moreover, global wasted work, global negative work and global systolic wasted work had the strongest correlation with the National Institutes of Health Stroke Scale score (P  < .001).Among these parameters, the ratio of global positive work/global negative work had the largest area (0.969, 0.938-1.001) under receiver operating characteristic curve in discriminating if the National Institutes of Health Stroke Scale score >15 or not. The optimal cutoff value was 3.89, with a sensitivity of 100%, a specificity of 93.0%, a positive predictive value of 84.9%, a negative predictive value of 100%, and an accuracy of 95.7%.

Conclusion: Noninvasive myocardial work is highly competent in assessing the severity of acute stroke and neurological deficits, which can be used as a powerful supplement to the conventional scoring system.

Background: Although pregnancy in women with pulmonary arterial hypertension has been considered a high-risk condition, current data regarding pregnancy with pulmonary arterial hypertension are scarce. In this study, we aimed to evaluate our single-center data on maternal and fetal outcomes in pregnant women with PAH and review currently available risk-based management strategies.

Methods: Our single-center study group comprised 35 women who became pregnant after the diagnosis of pulmonary arterial hypertension or in whom pulmonary arterial hypertension was diagnosed within early post-partum period. Clinical, laboratory, echocardiographic, and hemodynamic characteristics of pregnant and non-pregnant productive women with pulmonary arterial hypertension were compared, and similar comparison was also repeated for survivors and non-survivors in pregnant patient group.

Results: Pregnancy was noted in 15% of the 228 females with pulmonary arterial hyper-tension who were of hormonally productive ages, generally well-tolerated until delivery. Elective abortion and pre-term delivery were documented in 1 (2.8%) and 12 (35.3%) pregnant women, respectively. Switching to sildenafil was the standard medication during pregnancy. Cesarian section was the preferred method of delivery in all pregnant women with pulmonary arterial hypertension and was performed without any complication. Clinic deteoriation within the first week of delivery was observed in 5 (41.6%) patients. Maternal mortality was noted in 13 (37.1%) patients and was documented to cumulate within the first month of delivery. However, any sign predicting post-partum clinical deterioration was not found. No fetal mortality was observed.

Conclusion: Despite the development of advanced therapies, pregnancy in pulmonary arterial hypertension still carries a high mortality risk and requires multi-disciplinary expert center care with more proactive management strategies.