Objective: To evaluate paroxysmal atrial fibrillation (AF) prevalence in Indian adults who completed 24-Hour Holter monitoring. Methods: A total of 23,847 patients (36.9 % women) were analyzed for AF duration using a software algorithm. Results: AF was diagnosed in 4153 (17.4 %) patients with a median AF duration of 13 min and 55 s. Conclusion: AF prevalence was high and largely untreated. The short duration of AF episodes indicates a low likelihood of detection during clinical visits, highlighting its potential underestimation in Indian healthcare.

Worsening heart failure (WHF) is a distinct under-diagnosed and under-treated condition, independent of location of care. Heart failure (HF) progression is punctuated by repeated WHF events, each resulting in reduced cardiac function. One-third of the patients with HF with reduced ejection fraction experience a decompensation event. These decompensation events often result in the emergency department visits and HF hospitalization. Despite its inclusion in recent guidelines, there is no precise definition of WHF or its various forms. It is worth noting that WHF signals a need for treatment optimization as per guideline-directed medical therapy and the addition of novel drugs like a stimulator of soluble guanylate cyclase that benefit this high-risk patient population. This practical document is based on the expert opinion of cardiologists, cardiothoracic surgeons, and physicians that discussed the definition, assessment, pharmacological management, and monitoring of WHF patients in a hospitalized setting. In addition, there is also a need for an expert opinion for the management of WHF in an outpatient setting.

Objective: Hypertension has been reported in 12.1% of young adults in a recent population-based study in India and is a growing concern. There is a paucity in guidelines on the definite therapeutic approach in young hypertensives. This study aimed to understand the clinician's perspective on approach to management of hypertension in young adults in India. Design and method: Cross-sectional observational survey conducted between February 6, 2020 and 22 February 22, 2020 using a structured 14-item questionnaire. Total of 2287 clinicians (cardiologists, diabetologists, consultant physicians, and family physicians) across India participated in this survey. Descriptive statistics were first computed. Inferential statistics, namely chi-square test was then run to test the associations among knowledge, awareness and practice among the respondents across India. Results: Prevalence of hypertension in young adults was observed in 10–30% by 64.8% participant clinicians. Smoking, mental stress and obesity were considered as the most common risk factors for hypertension in young adults. Parameters of sympathetic overactivity in young hypertensive patients were considered as only increased systolic blood pressure, only increased heart rate and both increased heart rate and increased systolic blood pressure by 15.1%, 24.2% and 57.4% of respondents respectively. Angiotensin II receptor blockers (ARBs) were considered the most appropriate class of drugs to treat hypertension in young by 61.6% respondents. Beta-blockers were preferred by 15.8%, followed by calcium channel blockers, diuretics and ACEI by 10.4%, 7.6% and 4.6% respondents respectively. Beta-blockers were selected as antihypertensive class in young hypertensive adults based on their perception of sympathetic overactivity by 74.5% respondents. Metoprolol was the preferred beta-blocker by 63.1% respondents. Combination therapy of telmisartan & metoprolol was preferred by 15.5%, 40.9%, 43.6% clinicians in young hypertension, uncontrolled hypertension, both young and uncontrolled hypertension patients respectively. Conclusions: This study adds to the real-world data in management strategies of young Indian hypertensives. Amongst the current class of anti-hypertensive drugs, ARBs and beta -blockers were preferred by the clinicians who participated in the study. Monotherapy and combination therapy with telmisaratan and metoprolol as a prototype of the respective anti-hypertensive class were preferred in the study.

Despite maintaining mean blood pressure at optimal levels, cardiovascular complications still occur in hypertensive patients. Blood pressure variability (BPV) has been implicated as a prominent factor responsible for incurring this additional risk. In this review we attempted to generate a consensus on the importance of BPV in the hypertension management and to evaluate different therapeutic options available to reduce BPV. Panel comprising of 11 leading experts from India in different areas of clinical practice (including nephrology, diabetes and endocrinology, cardiology, and critical care medicine) was convened. The board reviewed up to date literature on BPV, shared personal experiences from their clinical practice, and debated their opinions on the significance of BPV in hypertension management and also on various therapeutic options available to control it. The reviewers agreed that BPV is frequently observed in hypertensive individuals and it is a critical factor in hypertension management. Blood pressure variability can be measured by ambulatory blood pressure monitoring, home blood pressure monitoring, and office blood pressure monitoring. Members concurred that variations in blood pressure that are 10 standard deviations above the mean blood pressure should be considered as pathologically significant and such variations should be reduced using pharmacological therapies. The board opined that Angiotensin II Receptor Blockers,Calcium Channel Blockers etc such as Olmesartan, Nifedipine can be used to reduce BPV. As a way forward, the panel recommends to bridge the evidence gap that establishes a possible direct relationship between BPV and cardiovascular complications. Blood pressure variability has paramount role in the current hypertension management scenario. To reduce disease burden and increase quality of life of hypertensive individuals, physicians should consider lowering BPV along with physiological BP levels.

Coronary artery perforation (CAP) is a rare (0.43%) but scary complication of percutaneous coronary intervention with its associated morbidity and even mortality at times.It needs to be treated urgently either by percutaneous means or by open heart surgery, as the situation demands. In this report we are discussing a left anterior descending coronary (LAD) artery perforation sealed successfully using cyanoacrylate glue.

Severe pulmonary stenosis presents early in life; late presentation is rare. Very late presentation like in our case is rarest of rare. Likewise calcification of pulmonary valve is rare. We describe here, one such case in an eighty-one year old female who astonishingly not only tolerated severe form of pulmonary stenosis but had also gone through three full term pregnancy, successfully without any untoward effect!

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

OBJECTIVES:This study aims to assess the safety and efficacy of a biodegradable polymer-coated Rapamycin-Eluting Stent (Excel) used in conjunction with six-month dual antiplatelet therapy in daily practice.BACKGROUND:The polymeric material of cardiac stents has been reported to adversely affect the safety profile of the drug-eluting stents and is also suspected to cause serious long-term complications. It has been proposed that the biodegradable polymer coatings may reduce such late-stage adverse effects.METHODS:This is a prospective, multi-center registry of 654 patients from across 9 cardiology centers in India, who were enrolled and exclusively treated with Excel stents between February 2008 and May 2010. The recommended antiplatelet regimen included clopidogrel and aspirin for 6 months period, followed by lifelong aspirin therapy.RESULTS:The study population included 46.94% diabetics, 24.31% smokers, 48.93% hypertensives and 14.98% hyperlipidemics. The cumulative rates of major adverse cardiac events were 0.153% at discharge and 1.38% at 12 months. The mean percentage of stenosis was 88.24 ± 9.17% No events occurred between 6 and 12 months.CONCLUSIONS:This multi-center registry study on "real world, all comers" has, thus, showed that EXCEL™ stent which is PLA-coated biodegradable Rapamycin-Eluting Stent exhibited high efficacy and safety profile in treatment of patients undergoing PCI as evidenced by significantly lower rates of MACE and no case of stent thrombosis. There was no event even after DAPT was discontinued after 6 months.

New generation DES are effectively used in all spectrum of coronary artery diseases (CAD) and are replacing earlier DES and BMS. Biolimus A9™-eluting stent is a new generation DES containing the anti-proliferative drug biolimus A9™ incorporating a biodegradable abluminal coating that leaves a polymer-free stent after drug release enhancing strut coverage while preventing neointimal hyperplasia. A retrospective data analysis was done in patients treated with DES, with a major share of Biolimus A9™ (BA9™) drug-eluting stents (DES) at Bombay Hospital, Mumbai. A total of 158 patients with 219 lesions were treated with DES, comprising Biolimus A9-eluting stent and others and the major adverse cardiac events (MACE) rate and stent thrombosis (ST) at 1, 6, 12 months and 24 months were analyzed. Mace rate was 3.16% for average follow-up of 19 months. There were 3 cases of ST (2 of acute and 1 of subacute onset) and one non-cardiac death reported during this time. This retrospective data demonstrates good one- and two-year clinical safety and efficacy of DES, especially of BioMatrix stents in real world setting.

Aortic dissection is a rare entity with an incidence estimated to be 5-30 cases per million people per year. It is more common in patients with hypertension, connective tissue disorders, congenital aortic stenosis or bicuspid aortic valve, and in those with first-degree relatives with history of thoracic dissections. Spontaneous dissections are rare. We describe one such case who was treated successfully with a endovascular stent graft without any local or systemic complication.

Isolated PPS is known in children. Mild/Moderate PPS remains stable over time. Severe PPS is progressive and patients are symptomatic but catastrophic events are not known in children. This is a rare case of severe PPS in a child with sudden cardiac death.