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All Journal Jurnal Kedokteran Brawijaya Indonesian Journal on Computing (Indo-JC) Heart Science Journal Jurnal Klinik dan Riset Kesehatan
Rizal, Ardian
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Biochemistry, Genetics & Molecular Biology Computer Science & IT Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Journal : Heart Science Journal

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Atrial Fibrillation Development Risk Associated with Metabolic Syndrome Alfata, Fandy Hazzy; Rizal, Ardian; Rohman, Mohammad Saifur; Rahimah, Anna Fuji
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.2

Abstract

Even in the absence of antecedent myocardial infarction or congestive heart failure, atrial fibrillation (AF) is the most frequent arrhythmia seen in daily practice. There are several important predisposing factors for the initiationof AF, including growing older, being a man, being female, having high blood pressure, and having cardiac and noncardiac illnesses. Metabolic syndrome (MS) contributes to the progression of AF through its impact on the atrial substrate. MS involves metabolic risk factors that increase the likelihood of atherosclerotic cardiovascular disease and type 2 diabetes. Insulin resistance plays a significant role in MS pathophysiology, leading to glucose and lipid metabolism dysregulation, increased inflammation, and neurohormonal activation. These processes contribute to the development of hypertension, a major risk factor for AF. Atrial remodeling, including electrical and structural changes, is a common substrate for AF, and MS components further contribute to this remodeling.Hypertension, a key feature of MS, is associated with structural, contractile, and electrical remodeling in the atria, increasing the risk of AF. The renin-angiotensin-aldosterone system, implicated in hypertension regulation, alsoinfluences the pathophysiology of AF through fibrosis, ion channel alterations, oxidative stress, and inflammation. Understanding the intricate interplay between MS and AF can provide insights into therapeutic strategies for managing these conditions and reducing cardiovascular risks.
Rapid degradation of left ventricular function after permanent right ventricular pacing in patients with high-grade atrioventricular block Setiawan, Dion; Prasetya, Indra; Anjarwani, Setyasih; Rizal, Ardian
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.22

Abstract

Background: Permanent right ventricular (RV) pacing is a standard for high-grade atrioventricular (AV) block treatment. However, it may result in left ventricular (LV) dilatation, systolic dysfunction, and heart failure (HF) as a consequence of ventricular dyssynchrony and an abnormal myocardial contraction pattern. Pacing-induced cardiomyopathy (PICM) can develop months or years after implantation of a permanent pacemaker (PPM) in patients who have long-term and high-burden RVP. Case Illustration: We reported a case of a 56 years old Asian female having a record of PPM on VVIR mode implantation due to a high grade AV block presented with shortness of breath and bilateral leg swelling. Conclusion: Echocardiography showed a significant decrease in LV systolic function less than two years after PPM implantation. Coronary angiography showed widely patent vessels; subsequently, His-Bundle Pacing (HBP) was scheduled on the patient.
Challenge case of ventricular arrhythmia in young women Kaputrin, Nur; Rizal, Ardian; Karolina, Wella; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.16

Abstract

Background: Torsade de pointes (TdP) and ventricular fibrillation can cause rapid mortality. The etiological cause the ventricular arrhythmia must be detected and treated early, especially in the ER. Objective: We report a patient with severe hypokalemia and TdP following the administration of Amiodarone in QT-interval prolongation Case Report: A 32-year-old girl with diarrhea and vomiting for two days arrived to the ED with a seizure with her hand flexed and leg straight down. Her family reported she didn't take prescriptions regularly. She was GCS 224, hemodynamically stable, typical ECG showed extended QTc and her head CT was normal. During observation at the ED, she had seizure and the monitor revealed a Torsade de Pointes (TdP) ) with a pulse rate of 160-180 bpm. She was given Amiodarone and peroral Bisoprolol 5 mg. She returned to sinus rhythm with PVC bigeminy and was admitted to the ICU Laboratory data showed hypokalemia (1.9) improved (2.9) after treatment. Eight hours later, she experienced a TdP without pulse palpability for less than 1 minute, then Ventricular Fibrillation, began CPR, and the doctor in charge gave her a defibrillation operation once. She returned with sinus tachycardia 110-130 bpm. The next day, she was having recurring TdP episodes without a pulse. The doctor conducted CPR and defibrillation and returned with 120-130 bpm sinus tachycardia. The patient consulted a cardiologist and was prescribed lidocaine 1 mg/hour and continued Bisoprolol 5 mg for long QT problem. Observation The seizure ended 12 hours later, the patient was alert, GCS 456, and the ECG showed sinus rhythm with extended QTc. Over the days before discharge, electrocardiography demonstrated reduced QT-interval prolongation. Conclusion: Life-threatening ventricular arrhythmia in a young female can be caused by QT-interval prolongation. It must be diagnosed and treated immediately to avoid mortality.
Case series analysis: Atrial fibrillation ablation with normal vs. left atrium enlargement Baskoro, Shalahuddin Suryo; Saerang, Gebryel Dennis; Saputri, Vemmy Lian; Rizal, Ardian; Wikananda, Adhika Prastya; Waranugraha, Yoga
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.15

Abstract

Background: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias, and its incidence is gradually increasing worldwide. It can develop such life-threatening conditions as heart failure, myocardial infarction, and thromboembolism. Catheter ablation, as a minimally invasive procedure to eliminate AF triggers, demonstrates different levels of success, particularly in relation to the size of the left atrium (LA). Even though left atrium enlargement (LAE) associates with worse ablation outcomes, its mechanisms are poorly understood. Case Illustration: This case report investigated the treatment results in AF ablation cases with normal LA size and LAE. This case report described two paroxysmal AF patients who underwent catheter ablation. The patient of the first case is a 45-year-old male with normal LA Size, while the second case is a 55-year-old male with LAE. Both of these patients underwent pulmonary vein isolation (PVI) using a 3D mapping system. Sinus rhythm was gained in both patients before the discharge and both performed the ablation successfully. Conclusion: Left Atrial Enlargement (LAE) exposed patient to more difficult procedures and greater risk of recurrence. LA size is one of the predictor of long term outcome in AF ablation patients, but with proper management, the prognosis might still be favourable. More studies need to determine how to manage AF ablation in patients with high-risk characteristics 
Atrial myopathy: a pathogenic mechanism linking atrial fibrillation and ischemic stroke Kahadi, Cik; Rizal, Ardian
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.2

Abstract

Atrial myopathy (AM) has become a topic of study for many years. Atrial Myopathy is characterized as "any variety of architectural, structural, electrophysiological, or contractile abnormalities altering the atria, which can result in clinically significant manifestations," and is associated with atrial dysfunction and dilatation. Evidence shows that atrial myopathy (AM) contributes to atrial fibrillation and embolic strokes of unknown origin. Atrial myopathy or disease provides a substrate leading to atrial fibrillation (AF) and contributes to a chance of atrial thrombus development and, finally, stroke. However, following clinical trials have opposed this point of view. Additionally, ischemic strokes are categorized as cryptogenic when an embolic stroke occurs without a known related etiology (embolic stroke of undetermined source, ESUS). This led to the concept of atrial myopathy, showing that a dysfunctional atrium may result in stroke without the incidence of atrial fibrillation. Atrial interstitial fibrosis, extracellular matrix deposition, and inflammation may trigger and perpetuate atrial myopathy, resulting in blood stasis inside the atria and potentially resulting in stroke without any intervening atrial fibrillation. This paper describes an overview of Atrial Myopathy in pathogenic mechanisms linking atrial fibrillation and ischemic stroke. Atrial myopathy is not only a substrate for atrial fibrillation and makes thrombus formation cause ischemic stroke, but also leads to blood stasis within the atria and makes ischemic stroke without intervening atrial fibrillation.
AF-CARE: The current approach in atrial fibrillation management Rizal, Ardian
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.1

Abstract

Despite improvements in treatment, atrial fibrillation (AF) continues to pose a serious threat to global health, with increasing rates of morbidity and mortality. By endorsing the AF-CARE approach, the 2024 ESC guidelines shift the paradigm from the conventional "CC to ABC" model and place more emphasis on patient empowerment, comorbidity management, and rhythm control. Important changes include promoting early catheter ablation for certain patients, as shown by the CABANA and EARLY-AF trials, and prioritising risk factor modification (such as obesity and sleep apnoea) as a therapeutic approach, backed by trials like LEGACY. The guidelines also emphasise patient-centred care, incorporating digital tools and education. The paradigm shift towards holistic AF management is highlighted in this editorial, which combines shared decision-making, lifestyle interventions, and technological innovation to enhance results.
Cardiac implantable electronic device infection - how to recognize and treat? Rochmawati, Icmi Dian; Rizal, Ardian
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.10

Abstract

Implantable Electronic Devices (CIEDs) have significantly transformed the treatment of various heart conditions. However, their growing use has been accompanied by an increase in device-related infections, posing a serious medical concern. Early identification of CIED infections is essential for prompt and effective treatment. Typical clinical signs include localized infection symptoms—such as redness, warmth, and tenderness around the implant site—as well as general symptoms like fever and fatigue. Diagnostic support also comes from laboratory tests, particularly elevated inflammatory markers. Management of these infections requires a coordinated, multidisciplinary approach. Timely removal of the infected device is critical, along with the administration of targeted antibiotics based on culture and sensitivity findings. In some instances, surgical removal of the entire device, including any leads, may be necessary. Preventing such infections is equally important and involves strict adherence to aseptic techniques during implantation and any subsequent procedures. Prophylactic antibiotics may also be warranted for patients at high risk. In summary, the successful management of CIED infections relies on early detection, accurate diagnosis, and a well-coordinated treatment plan. Preventive measures are vital in decreasing infection rates and ensuring the best possible outcomes for patients.
Hype or hope: The role of alcohol septal ablation in improving outcomes for young patients with obstructive hypertrophic cardiomyopathy: A case series Saputri, Vemmy Lian; Rizal, Ardian; Rahimah, Anna Fuji; Karolina, Wella; Yogibuana, Valerinna; Prasetya, Indra
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.19

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is a disease that has a poor prognosis and a higher likelihood of death in young people. Alcohol septal ablation (ASA) is a minimally invasive procedure that involves the injection of ethanol through a septal perforator to lead to infarction of the hypertrophied septum. This case series aims to present data on the beneficial effects of ASA in promoting hope for enhanced outcomes in young patients with HCM. Case: Patient 1: A 32-year-old male with HCM has been suffering from chest discomfort and atrial fibrillation since 2020. Echocardiography detected an increased obstruction in the left ventricular outflow tract (LVOT), resulting in a gradient of 104 mmHg. The patient underwent ASA to decrease the gradient to 37 mmHg, reducing hospitalizations throughout a 12-month follow-up period. Patient 2: A 27-year-old female diagnosed with HCM has been frequently suffering episodes of near syncope and shortness of breath with light activity over the past 6 months. The echocardiography findings showed a significant increase in the resting gradient in the LVOT. Following ASA, the resting gradient decreased to 54 mmHg during a 3-month follow-up. The patient did not suffer further near syncope events, and her NYHA functional class improved throughout a 9-month follow-up period. Conclusion: The effectiveness of ASA as a treatment option is hope for young patients with obstructive HCM, which is demonstrated in this case series, leading to relieving symptoms, reduced repeated hospitalization, and improved functional capacity.
When coronary anomalies induce arrhytmias: A case of ventricular tachycardia due to left coronary artery-pulmonary artery fistula Saerang, Gebryel Dennis; Rizal, Ardian; Karolina, Wella
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.20

Abstract

Background: Coronary artery fistula (CAF) is a rare vascular anomaly involving an abnormal connection between a coronary artery and another cardiac or vascular structure. Although often asymptomatic, CAF can cause myocardial ischemia, presenting as angina, dyspnea, or ventricular arrhythmias, due to flow diversion, leading to a coronary stealing phenomenon that poses a serious clinical challenge. Case: An 81-year-old female presented with chest pain, palpitations, and syncope. Electrocardiography (ECG) showed monomorphic VT, successfully cardioverted and managed with amiodarone. Following initial stabilization, she experienced recurrent episodes of VT that were terminated with lidocaine. Physical examination revealed a continuous machinery murmur at the left upper sternal border. Transthoracic echocardiography showed left coronary artery dilation with turbulent flow into the pulmonary artery. Aortography and coronary angiography confirmed a dilated left main coronary artery with an aneurysmal segment and a tortuous fistulous tract to the pulmonary artery. Computed tomography coronary angiography (CTCA) with 3D reconstruction confirmed a left coronary artery fistula to the pulmonary artery. Conclusion: This case highlights CAF as an uncommon yet clinically important etiology of recurrent VT, likely attributable to the coronary stealing phenomenon. Multimodal imaging, especially CTCA, is crucial for diagnosis and treatment planning. In addition to immediate management with cardioversion/defibrillation and antiarrhythmic drugs, treatment of ischemia as the underlying cause is important in the management of ischemia-induced VT. CAF closure is recommended in symptomatic or hemodynamically significant CAF to alleviate ischemic symptoms and prevent complication.
Ventricular Tachycardia Storm Management in Acute Cardiac Care: Prompt response to life-threatening conditions Lestari, Puspa; Anjarwani, Setyasih; Rohman, Mohammad Saifur; Rizal, Ardian
Heart Science Journal Vol. 4 No. 1 (2023): Optimizing Outcome in Acute Cardiac Care
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.01.7

Abstract

Background: Ventricular Tachycardia (VT) storm or electrical storm (ES) is defined as cardiac electrical instability and refers to the occurrence of three or more ventricular tachyarrhythmias (VT and or ventricular fibrillation (VF)) in a 24-hour period, or VT recurring soon (within five minutes) after termination of another VT episode, or sustained or no sustained VT with total ectopic beats greater than sinus beats in a 24-hour period. The frequency of VT storms varies on population. When ICDs are implanted for primary prevention (4 percent), it is lower than when they are implanted for secondary prevention (20 percent).Case Summary: We presented patient with Ventricular Tachycardia (VT) storm. A 63-year old woman was admitted to emergency room with chief complaint frequent episodes of palpitation. She was found to have monomorphic VT with unstable hemodynamic. Then she got cardioversion 100 Joule, continued with lidocaine drip and VT reverted to sinus rhythm. Patient admitted to cardiovascular care unit, but she had VT refractory. She got complete revascularization for coronary artery before, but the episodic of VT still occurred with cardiogenic shock (CS) and pulmonary edema. She got cardioversion, amiodarone iv and inotropes, then observed this patient at CVCU. After the condition stable, this patient was discharged and planned for ICD insertion at the next admission.Discussion: We discuss the various available treatment options for VT storm and practical challenges faced in management of hemodynamically unstable VT storm. Initial management involves identifying and correcting the underlying ischemia, electrolyte imbalances, or other inciting factors.
Co-Authors Adi Nugroho, Dwi Adi, Andi Wahjono Alfata, Fandy Hazzy Anjarwani, Setyasih Arif Wicaksono Astiawati, Tri Aziz, Indra Jabbar Bahar, Mokhamad Aswin Baskoro, Shalahuddin Suryo Cholid Tri Tjahjono Cik, Kahadi Djanggan Sargowo Dwigustiningrum, Nur Kaputrin Fikry, Maurice Galuh, Lukitasari Ayu Haryati, Lina Indra Prasetya Inggita Kusumastuty Kahadi, Cik Kaputrin, Nur Karolina, Wella Kurnianingsih, Novi Kurniawan, Dea Arie Laitupa, Fitranti Suciati Lestari, Puspa Martini, Heny Mohammad Saifur Rohman Noverike, Nikhen Nugraha, Krishna Ari Nugraha, Yudha Tria Pramudyo, Miftah Putri, Valerinna Yogibuana Swastika Rahimah, Anna Fuji Rochmawati, Icmi Dian Saerang, Gebryel Dennis Saputri, Vemmy Lian Satria Mandala Satrijo, Budi Satwikajati, Sawitri Setiawan, Dion Suprapto, Ratih Paramita Suprayoga, Imam Mi'raj Titin Andri Wihastuti Widito, Sasmojo Wikananda, Adhika Prastya Yoga Waranugraha Yogibuana, Valerinna