Atrial fibrillation (AF) is the most common sustained cardiac arrhythmias and associated with the risk of stroke and death. Continuous development of the diagnostic tool and prognostic stratification may lead to optimal management of AF. The use of biomarkers in the management of AF has been grown as an interesting topic. However, the AF biomarkers are not yet well established in the major guidelines. Among these biomarkers, a lot of data show troponin and brain natriuretic peptides are promising for the prediction of future events. The troponin elevation in AF patients may not necessarily be diagnosed as myocardial infarction or significant coronary artery stenosis, and brain natriuretic peptide elevation may not necessarily confirm heart failure. Troponin T and troponin I may predict postoperative AF. Furthermore, troponin and brain natriuretic peptide gave better prognostic performance when compared with the risk score available today.

Background: Data on the optimal therapeutic international normalized ratio (INR) for non-valvular and valvular atrial fibrillation (AF) in Indonesia is currently unavailable. Therefore, we designed the Indonesian Registry on Atrial Fibrillation (OneAF) registry in order to seek a safe and beneficial range of INR in Indonesian patients with non-valvular and valvular AF. Methods/design: The OneAF registry is a nationwide collaboration of the Indonesian Heart Rhythm Society (InaHRS) enrolling all hospitals with cardiac electrophysiologists in Indonesia. It is a prospective, multicentre, nationwide, observational study aiming to recruit non-valvular and valvular AF patients in Indonesia. The registry was started in January 2020 with a planned 2 years of recruitment. There are 2 respondents for this registry: non-cohort and cohort respondents. Non-cohort registry respondents are AF patients at hospitals who fulfill inclusion and exclusion criteria but did not consent for a 24 month follow up. Whereas patients who consented for a 24 month follow up were included as cohort registry respondents. Key data collected includes basic sociodemographic information, symptoms and signs, medical history, results of physical examination and laboratory test, details of diagnostics and treatment measures and events. Results: Currently, a total of 1568 respondents have been enrolled in the non-cohort registry, including 1065 respondents with non-valvular AF (67.8%) and 503 respondents with valvular AF (32.2%). We believe that the OneAF registry will provide insight into the regional variability of anticoagulant treatment for AF, the implementation of rhythm/rate control approaches, and the clinical outcomes concerning cardiocerebrovascular events. Trial registration: Registered at clinicaltrials.gov (NCT04222868).

Background: A ‘STEMI equivalent’ electrocardiogram (ECG) pattern describes an acute thrombotic occlusion of a large coronary artery without ST-segment elevation. This pattern must be recognized and treated with emergent reperfusion therapy. De Winter syndrome is a special ECG pattern reflecting acute occlusion in the proximal segment of LAD (left anterior descending) coronary artery and a primary percutaneous coronary intervention (PCI) should be performed as early as possible.Case illustration: We present two patients admitted to the emergency department with symptoms of chest pain. Their ECGs revealed de-Winter T waves and then coronary angiography was performed. Total occlusion in the proximal segment of the LAD coronary artery was observed in both patients, and stents were implanted to the culprit lesion. Both ECG patients show an up-sloping ST-segment depression (STD, >1 mm) starting from the J-point, with symmetrical, tall and significant T-waves in the precordial leads. This ECG pattern indicates a LAD coronary artery obstruction. The ‘de Winter’ ECG pattern is not mentioned in the ESC guidelines, but it is essential to recognize this rare ECG pattern as the STEMI equivalent, and it must be treated with prompt revascularization therapy.Conclusion: The ‘de Winter’ ECG pattern, as other ‘STEMI equivalent’, must be recognized promptly and treated as soon as possible with emergent reperfusion by percutaneous coronary intervention.

Background: Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) is still an issue in modern revascularization era. Recent risk stratification model used creatinine as biomarker which has some limitations. Increased ≥ 10 % of Cystatin-C after PCI has proven to be one of the earliest and accurate CIN after PCI biomarkers. The study aims to develop risk score based on predictors of contrast-induced nephropathy in patients after PCI with Cystatin-C as biomarkerMethods: A prospective cohort study of 129 patients after PCI at Dr. Kariadi General Hospital Semarang. Predictor analysis was carried out using bivariate chi-square test and multivariate logistic regression. The independent predictors obtained were then used as risk score variables. The Hosmer and Lemeshow calibration test and AUC ROC analysis for discrimination test tested the quality of the risk score.Results: There were 3 independent predictors used as the risk score variables: Hypotension (score 1), anemia (score 1), creatinine baseline >1.5 mg/dl (score 1). Patients with total score ≥1 have higher risk to have CIN after PCI. The risk score had a good quality with the Hosmer and Lemeshow calibration test > 0.05 and relative modest discrimination ROC AUC 0.700 (95% IK 0.585-0.815;  p=0.001).Conclusions: A risk score for risk stratification CIN after PCI has been created. The score has  good calibration and modest discrimination in predicting the risk of CIN after PCI.