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All Journal Cardiovascular and Cardiometabolic Journal (CCJ)
Emmanuela, Mirela
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology

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Investigation on Prediction of Life-Threatening Arrhythmia in Long QT Syndrome : A Systematic Review and Meta-Analysis Lee, Jonathan Vincent; Emmanuela, Mirela; Lee, Jonathan Bryan
Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 6 No. 1 (2025): Cardiovascular and Cardiometabolic Journal
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ccj.v6i1.2025.26-38

Abstract

Introduction : Use of risk stratification tools in  Long QT Syndrome (LQTS) will be important to direct treatment strategy on each patient and risk of arrhythmia. There are still other factor that could improve the predictive performance of the risk stratification. This study aims to find a new predictor of Life-Threatening Arrhythmia in the LQTS population. Methods : Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol  (PRISMA) Protocol 2015,  studies  extracted  from  Pubmed, Science Direct, Pubmed Central, EuroPMC, Frontiers with MeSH keywords “Long QT Syndrome AND Predictor AND Life-threatening arrhythmia”. The inclusion criteria were cohort studies in LQTS patients (LQT 1, 2, 3) and the endpoint was life-threatening arrhythmia such as aborted cardiac arrest or sudden cardiac death. Study quality assessed with Newcastle-Ottawa Scale and RevMan 5.4 were used to analyse the data with hazard ratio as the measures. Results : Six  cohort studies  (12.343  subjects)  fulfilled  the  inclusion  criteria. Male <13 years old (HR = 2.73, 95% CI = 1.72-4.33, p = <0.0001) and female >13 years old (HR = 1.81, 95% CI = 1.36-2.41, p = <0.0001) were significant as predictor of life-threatening arrhythmia. Patients with LQT2 (HR = 1.84, 95% CI = 1.36-2.49, p = <0.0001), LQT3 genotype (HR = 3.88, 95% CI = 2.27-6.62, p = <0.00001), and QTc >530 (HR = 2.45, 95% CI = 1.96-3.06, p <0.00001) were also at increased risk of life-threatening arrhythmia.  Syncope occurrence increased the risk (HR = 3.11, 95% CI = 2.47-3.91, p = <0.00001) while beta-blockers usage significantly decreased the risk of life-threatening arrhythmia (HR = 0.46, 95% CI = 0.36-0.60, p = <0.00001). All studies were low risk of bias. Conclusion : There were other predictors of life-threatening arrhythmia in LQTS that might be considered to improve the stratification performance. -- Highlights: 1. In patients with Long QT Syndrome, life-threatening arrhythmia risk is strongly predicted by age-dependent gender differences, prolonged QTc (>530 ms), prior syncope, genotype (LQT2/3), and mitigated by beta-blocker use—offering a sharper edge for clinical risk stratification.
Cardiac Tamponade in Post-CABG Surgery Patient: A Case Report of Post-Pericardiotomy Syndrome Lee, Jonathan Vincent; Emmanuela, Mirela; Lee, Jonathan Bryan; Damay, Vito Anggarino
Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 6 No. 2 (2025): Cardiovascular and Cardiometabolic Journal
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ccj.v6i2.2025.118-124

Abstract

Background: Cardiac tamponade is the situation where fluid accumulates in the pericardial cavity and compresses the heart, which leads to reduced cardiac output and shock. Their prevalence in post-open heart surgery, especially Coronary Artery Bypass Graft (CABG) surgery is 24% and commonly related to Post-Pericardiotomy Syndrome (PPS). Case Summary: A 57-year-old female with a history of CABG surgery presented to emergency with chief complaints of shortness of breath in the last 3 days, especially when lying down. The patient underwent CABG surgery from CAD2VD + LM in the last month. Physical examination found a muffled first & second heart sound and distended jugular vein. The electrocardiograph of the patient showed sinus rhythm with low voltage. Echocardiography was done on the patient, and the result showed severe pericardial effusion with a D shape and collapse of the right ventricle. We performed a pericardiocentesis with an initial drainage of 737 cc of serosanguineous fluid. Post-procedural echocardiography showed reduced pericardial effusion, good LV contractility, and RV not collapsed. Pericardial fluid analysis concluded it was a transudative type. Patient were stable on admission and discharged uncomplicated. This patient developed cardiac tamponade with a history of CABG surgery. Conclusion: Cardiac tamponade occurs frequently in post-CABG surgery patients, both in early and late onset. It is important to recognize the early signs of cardiac tamponade, as the condition does not always present during the early phase. This case also highlighted the importance of recognizing and preventing PPS as a delayed cause of tamponade, even when there is no apparent sign of systemic inflammation. -- Highlight: 1. A 57-year-old post-CABG patient presented with cardiac tamponade one month after surgery, ultimately diagnosed as post-pericardiotomy syndrome (PPS) based on clinical and imaging findings. 2. Prompt echocardiography-guided pericardiocentesis and recognition of PPS as a delayed inflammatory cause of tamponade highlight the importance of vigilance for late-onset complications after cardiac surgery.
Co-Authors Damay, Vito Anggarino Lee, Jonathan Bryan Lee, Jonathan Vincent