Activation of the renin-angiotensin system (RAS) is associated with atrial fibrillation (AF). The aim of this study was to investigate the relation between AF and polymorphisms in RAS. One hundred and fifty patients with AF, 100 patients with no documented episode of AF and 100 healthy subjects were consecutively recruited into the study. The angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism, and the M235T, A-20C, and G-6A polymorphisms of the angiotensinogen gene were genotyped. Patients with AF had significantly lower frequency of II genotype of ACE I/D and higher frequency of angiotensinogen M235T polymorphism T allele and TT genotype and G-6A polymorphism G allele and GG genotype compared with the controls. AF patients had significantly larger left atrium, higher left ventricular mass index (LVMI) and higher frequency of significant valvular pathology. ACE I/D polymorphism II genotype, angiotensinogen M235T polymorphism TT genotype and G allele and GG genotype of angiotensinogen G-6A polymorphism were still independently associated with AF when adjusted for left atrium, LVMI and presence of significant valvular pathology. Genetic predisposition might be underlying the prevalence of acquired AF. Patients with a specific genetic variation in the RAS genes may be more liable to develop AF.

Objective: To assess and identify the risk of prolonged QT about hydroxychloroquine (HQ) and azithromycin (AZ) used in the treatment of patients with COVID-19.

A fifty-four-year-old female patient was admitted to our unit with exertional chest pain of six months duration. Transthoracic echocardiography showed apical hypertrophy. Upon further investigation, cardiac magnetic resonance imaging revealed apical hypertrophic cardiomyopathy. The patient underwent myocardial perfusion scintigraphy which showed anterior ischemia. Coronary angiography revealed an arteriovenous fistula (AVF) from the left anterior descending artery to the pulmonary artery. The patient's chest pain was attributed to a coronary steal syndrome secondary to the coronary AVF. The AVF fistula was closed with a coil and the patient's chest pain improved. In conclusion, coronary steal syndrome may lead to myocardial ischemia in patients with a coronary AVF.

plaque with superimposed thrombus is the basic pathophysiology of the myocardial infarction and distal embolization of thrombus during primary percutaneous coronary interventions (PCI) results in impaired myocardial perfusion and lower thrombolysis in myocaridal infarction (TIMI) flow grade. 1,2 Published reports demonstrate that adjunctive thrombus aspiration in ST-elevation myocardial infarction (STEMI) improves markers of myocardial reperfusion with limited improvement in survival. [3][4][5] Although it is known to be a quick and easily applicable procedure, some complications can be seen. We report an octogenarian with a trapped thrombus in guiding catheter during thrombus aspiration and complete flow restoration without any additional angioplasty or stent implantation. Case PresentationAn 80-year-old female presented with severe, ongoing chest pain for the last 1 hour. On physical examination, blood pressure was 100/60 mm Hg, and heart rate was 40/min. The electrocardiography showed third-degree atrioventricular block with ST-segment elevations in leads II, III, aVF, and reciprocal ST depression in leads V1-4. After administration of 600 mg clopidogrel, 300 mg aspirin, and 5,000 units of unfractionated heparin, the patient was immediately transferred to the cardiac catheterization laboratory. A temporary pacemaker lead was placed at right ventricle apex. By using a 6F JR4 guiding catheter, angiography revealed filling defect and total occlusion of distal right coronary artery (►Fig. 1a). After advancing of 0.014 inch floppy guidewire and passing through the lesion distally, thrombus aspiration was performed by using a StemiCath manual thrombus aspiration catheter (Minvasys, Gennevilliers, France). After few seconds, interruption of blood flow in the syringe was noticed and catheter was removed with ongoing suction. There was not any thrombus material in suction syringe or aspiration catheter and there was no spontaneous bleeding from hemostasis valve (y connector) tip. By negative aspiration of the guiding AbstractPublished reports demonstrate improved myocardial reperfusion with adjunctive thrombus aspiration in ST-elevation myocardial infarction (STEMI). However, implementation of this procedure without angioplasty or stent implantation is not clear. In this report, we present an octogenarian with inferior STEMI who was treated with thrombus aspiration alone. Another important feature of our case is trapped thrombus material in the guiding catheter during thrombus aspiration. Operators should avoid thrombus reinjection by controlling the system carefully during aspiration procedure.