Abstract 741: Atrial Fibrillation Begets Atrial Fibrillation: Acute Autonomic Remodeling Leads to Enhanced Inducibility for Atrial Fibrillation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Zhibing Lu ◽  
Benjamin J Scherlag ◽  
Guo-Dong Niu ◽  
Jiaxiong Lin ◽  
Muhammad Ghias ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Atrial Pacing ◽  
Time Period ◽  
Before And After ◽  
Rapid Pacing ◽  
Group 2 ◽  
Window Of Vulnerability ◽  
Group 1

Introduction: There have been many forms of remodeling reported to play a role in the concept of “atrial fibrillation (AF) begets atrial fibrillation.” The role of intrinsic cardiac nervous system (ICNS) in this remodeling process was evaluated in this study. Methods: Continuous rapid pacing (1200 bpm, 2× threshold, TH) was performed at the left atrial appendage to maintain AF. Group 1 (N=7): 6-hours of pacing followed by ganglionated plexi (GP) ablation, both left and right side; Group 2 (N=7): GP ablation followed by 6-hours of pacing. At 2x and 10x TH, the effective refractory period (ERP) and window of vulnerability (WOV), i.e., longest-shortest coupling of premature stimulus which induced AF in milliseconds (ms), were measured at the left atrium, right atrium and pulmonary veins (PVs) every hour during the 6-hours of pacing before and after GP ablation. Results: In group 1 (rapid pacing with GP intact) ERP progressively shortened in the first two hours and then stabilized both at 2×TH and 10×TH (Figure 1A ), however, WOV progressively widened throughout the time period (Figure 1B ). After GP ablation, ERP was significantly longer than prior to ablation and AF could not be induced (WOV=0, p<0.01) at any pacing site at either 2×TH or 10×TH (Figure 1B ). In group 2 (initial GP ablation), ERP exhibited a slightly increasing trend as the pacing time increased. AF could not be induced in 6/7 dogs during the 6-hour pacing, and was inducible in 1/7 with a cumulative WOV of only 10 ms. Conclusion: The ICNS is crucial for the process of “AF begets AF” in the acute stages of remodeling by rapid atrial pacing.

Role of pertussis toxin-sensitive G protein in metabolic vasodilation of coronary microcirculation

2000 ◽  
Vol 279 (4) ◽  
pp. H1819-H1829 ◽  
Author(s):  
Toshinori Tanikawa ◽  
Hiroshi Kanatsuka ◽  
Ryohji Koshida ◽  
Mitsuaki Tanaka ◽  
Akihiko Sugimura ◽  
...  
Keyword(s):  
G Protein ◽  
Pertussis Toxin ◽  
Atrial Pacing ◽  
Metabolic Demand ◽  
Before And After ◽  
Vehicle Treatment ◽  
Rapid Pacing ◽  
Metabolic Stimulation ◽  
Metabolic Vasodilation

We have previously demonstrated that pertussis toxin (PTX)-sensitive G protein (GPTX) plays a major role in coronary microvascular vasomotion during hypoperfusion. We aimed to elucidate the role of GPTX during increasing metabolic demand. In 18 mongrel dogs, coronary arteriolar diameters were measured by fluorescence microangiography using a floating objective. Myocardial oxygen consumption (MV˙o 2) was increased by rapid left atrial pacing. In six dogs, PTX (300 ng/ml) was superfused onto the heart surface for 2 h to locally block GPTX. In eight dogs, the vehicle (Krebs solution) was superfused in the same way. Before and after each treatment, the diameters were measured during control (130 beats/min) and rapid pacing (260 beats/min) in each group. Metabolic stimulation before and after the vehicle treatment caused 8.6 ± 1.8 and 16.1 ± 3.6% dilation of coronary arterioles <100 μm in diameter (57 ± 8 μm at control, n = 10), respectively. PTX treatment clearly abolished the dilation of arterioles (12.8 ± 2.5% before and 0.9 ± 1.6% after the treatment, P < 0.001 vs. vehicle; 66 ± 8 μm at control, n = 11) in response to metabolic stimulation. The increases in MV˙o 2 and coronary flow velocity were comparable between the vehicle and PTX groups. In four dogs, 8-phenyltheophylline (10 μM, superfusion for 30 min) did not affect the metabolic dilation of arterioles (15.3 ± 2.0% before and 16.4 ± 3.8% after treatment; 84.3 ± 11.0 μm at control, n = 8). Thus we conclude that GPTXplays a major role in regulating the coronary microvascular tone during active hyperemia, and adenosine does not contribute to metabolic vasodilation via GPTX activation.

scholarly journals Benefits of prescribing low-dose digoxin in atrial fibrillation

2021 ◽  
Vol 35 ◽  
pp. 205873842110519
Author(s):  
Ciprian Ilie Rosca ◽  
Nilima Rajpal Kundnani ◽  
Anca Tudor ◽  
Maria-Silvia Rosca ◽  
Violeta-Ariana Nicoras ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Low Dose ◽  
Beta Blockers ◽  
Treatment Protocol ◽  
Factor Xa ◽  
Group 2 ◽  
Clinical Records ◽  
The Impact ◽  
Group 1

Introduction The role of digoxin (cardiac glycoside) in controlling the heart rate (HR) for the treatment of atrial fibrillation (AF) patients has not been explored in depth. Methods To contribute to the limited data, our team conducted retrospective analysis of the clinical records of 1444 AF patients. We divided the AF patients into two groups, wherein group 1 patients were treated with beta-blockers (BB), low-dose digoxin, and an anticoagulant (vitamin K antagonist/factor-IIa inhibitor/factor-Xa inhibitor), and group 2 patients were treated with just BB and an anticoagulant. Our objectives were to compare the impact of combination therapy of BB and digoxin on the resting HR in patients with permanent AF and the patients’ quality of life (QOL) at periodic intervals. Results The findings of our study showed a better control of the resting HR rate (<110bpm) and an improved QOL among the group 1 patients when compared with group 2 patients. Conclusion Our findings are indicative of the favorable clinical outcomes that resulted from the addition of a low-dose of digoxin to the AF treatment regimen. However, larger studies/trials elucidating the outcomes of AF patients treated with the dual rate control therapy are required, to clarify the role of digoxin, guide the choice of agents, and standardize the AF treatment protocol.

Abstract 16896: Electrogram Morphology Recurrence to Characterize Drivers of Persistent Atrial Fibrillation: Findings at Initial versus Redo Catheter Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ghaith Zaatari ◽  
Jorge Bohorquez ◽  
Raul Mitrani ◽  
Jason Ng ◽  
Justin Ng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Cycle Length ◽  
Cross Correlation ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Success Rates ◽  
Mapping Tool ◽  
Group 2 ◽  
Group 1

Background: Electrogram (EGM) morphology recurrence (EMR) mapping of persistent atrial fibrillation (PeAF) quantifies consistency of activation at each site and is expected to be high and rapid near drivers of PeAF. Objective: To compare EMR in the left (LA) and right atrium (RA) in patients undergoing first- vs second-time PeAF catheter ablation (CA). Methods: Multisite bipolar EGM mapping of the LA (265±153 sites) and RA (224±148 sites) prior to CA for PeAF was performed in 40 patients (29 males, age 63±9 yrs, CHA2DS2-VASc 2.4±1.5, LVEF 48±12%) undergoing first (Group 1, n=31) or second-time (Group 2, n=9) CA. After cross-correlation of each automatically detected EGM with every other EGM in the recording, the most recurrent EGM morphology was identified and its frequency (Rec%) and cycle length of recurrence (CL R ) were computed (figure). The minimum CL R sites were identified. Results: In group 1, shortest CL R was in the LA in 26 patients (84%) and RA in 5 patients (16%). In the LA, there were 1 (n=23), 2 (n=2), or 3 (n=1) areas of shortest CL R , most commonly in the pulmonary veins (PV; n=19). In the RA, there was only 1 area of shortest CL R . Minimum CL R was 174.1±25.4 ms (LA-179.6±37.4 vs RA-207.9±34.5, p=0.0004), with Rec% 95±10%. In group 2, shortest CL R was in the LA in 5 patients and RA in 5 patients (56%)– one had both LA and RA. In the LA/RA, there were 1 (n=3/4) or 2 (n=2/1) areas of shortest CL R . The most common LA site was non-PV (6/7, 85.7%). The minimum CL R was 182.1±26.2ms (LA-190.8±36.2 vs RA-196.0±30.5, p=0.6), with Rec% 96±5%. Conclusion: In 61% of patients undergoing initial CA for PeAF, EMR identified LA drivers in the PVs which may explain why PV isolation has been reported to have 50-60% success rates in PeAF. In patients undergoing a 2 nd ablation for PeAF, EMR identified predominantly nonPV drivers with even distribution of shortest CL R between RA and LA and diminished CL R gradient between the LA and RA. EMR may be a useful mapping tool to characterize potential drivers of PeAF.

P981Predictor factors and the prognostic role of persistent pulmonary veins isolation in patients with arrhythmia recurrence necessitating a second ablation procedure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Vevecka ◽  
C Schwab ◽  
M Forkmann ◽  
T H Fischer ◽  
S Butz ◽  
...  
Keyword(s):  
Low Voltage ◽  
Pulmonary Veins ◽  
Clinical Profile ◽  
Prognostic Role ◽  
Ablation Procedure ◽  
Group 2 ◽  
Artery Disease ◽  
Predictor Factors ◽  
Group 1

Abstract Aims Pulmonary vein isolation (PVI) is the treatment of choice in patients (pts) with symptomatic atrial fibrillation. Durable pulmonary veins isolation (PVI) seems to be associated with a lower risk of AF recurrence, but the predictor factors of persistent PVI are still uncertain. We aimed to determinate the predictor factors and the prognostic role of persistent pulmonary veins isolation in pts with arrhythmia recurrence necessitating a second ablation procedure. Methods and results Our Study included 102 pts (65.7% male, 65±8 years old, 75.5% persistent AF) with arrhythmia recurrence, whom underwent a Redo-PVI between October 2016 and Mars 2018. Patients were divided into two groups regarding the persistence of PVI. Group 1 included 20 pts with persistent PVI and Group 2 included 82 pts with reconnection of at least one PV. The clinical profile, ablation data and three months arrhythmia recurrence were analyzed. There were no statistical differences in terms of clinical profile between the two groups of pts (age; p=0.513, gender; p=0.299, BMI; p=0.077, diabetes mellitus; p=0.621, coronary artery disease; p=0.787; arterial hypertension; p=0.732; left ventricle ejection fraction; p=0.323 and left atrial diameter; p=0.5). Patients in group 1 presented more often with atrial tachycardia compared to group 2 Patients (30% versus 7.3%; p=0.014). Regarding the ablation data, there were no differences between the two groups in terms of procedure time (p=0.710) but the ablation time was longer in group 2 patients (29.1±13.7 versus 20.8±10.5 min. p=0.031). Low voltage areas (LVA) acquired by bipolar electroanatomical mapping were more often and diffuse in group 1 patients (70% versus 40.3%; p=0.050). The three months arrhythmia recurrence after Redo-Ablation was the same between the two groups (p=1.000). Conclusion The type of arrhythmia recurrence and low voltage areas are predictor factors of persistent pulmonary veins isolation in patients with arrhythmia recurrence necessitating a second ablation procedure. This fact can help in planning the second ablation procedure. Persistent PVI seems to have no prognostic role regarding the three months arrhythmia recurrence after Redo-Ablation.

scholarly journals Keratinized Gingiva Determines a Homeostatic Behavior of Gingival Sulcus through Transudation of Gingival Crevice Fluid

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Maria Luiza P. Lagos ◽  
Adriana Campos Passanezi Sant'Ana ◽  
Sebastião Luiz Aguiar Greghi ◽  
Euloir Passanezi
Keyword(s):  
Tissue Fluid ◽  
Gingival Margin ◽  
Before And After ◽  
Group 2 ◽  
Shed Light ◽  
Group 1

Objective. To shed light on the role of KG, its influence on periodontal behavior was investigated.Methods. Tissue fluid transudation was assessed in alveolar mucosa (P1A), outer gingival margin (P1B), at entrance of (P2) and within gingival sulcus (P3), before and after chewing of fibrous food in 16 patients portraying ≥2 mm KG at one tooth (group 1), and <2 mm at another homologous tooth (group 2).Results. There was a significant increase in GCF after chewing at P1B and P3 in group 1 and at P1A in group 2 (t-test, ).Conclusions. The results suggest that KG plays a role in marginal periodontal homeostasis.

Increasing the Dialysis Volume and Frequency in a Fixed Period of Time in CPD Patients: The Effect on Kpt/V and Creatinine Clearance

2002 ◽  
Vol 22 (6) ◽  
pp. 693-697 ◽  
Author(s):  
Peter H. Juergensen ◽  
A. Lola Murphy ◽  
Alan S. Kliger ◽  
Fredric O. Finkelstein
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Large Body ◽  
New Haven ◽  
Time Period ◽  
Baxter Healthcare ◽  
Group 2 ◽  
Fixed Period ◽  
Group 1

Background The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) has evidence- and opinion-based recommendations for weekly Kt/Vurea and weekly total creatinine clearance (CC) in chronic peritoneal dialysis (CPD) patients. Using standard continuous ambulatory peritoneal dialysis technique, it is often difficult to achieve the suggested targets in anuric patients with large body mass. Thus, the use of automated peritoneal dialysis (APD) has been increasingly utilized to achieve adequate clearances. Automated dialysis is usually performed at night over an 8- to 10-hour period. The role of increases in dialysate volume and frequency of exchanges during this time period to achieve these target K/DOQI recommendations remains uncertain. We decided to study the effects of increasing the volume and number of exchanges in a fixed period of time in CPD patients. Methods In the New Haven CAPD unit, 29 patients maintained on APD were considered eligible for the study and 11 agreed to participate. The patients were characterized according to standard peritoneal equilibration test criteria. The patients were placed into two groups: group 1 included high (H) and high-average (HA), and group 2 low-average (LA) transporters. The patients were dialyzed at night for 9 hours with standard cycling technique, using 2.5% Dianeal (Baxter Healthcare, Deerfield, Illinois, USA) solution, with a cycle volume of 2500 mL, and a 2000-mL daytime dwell. Three studies were done on each patient using a total dialysis volume of 9.5 L (3 cycles), 14.5 L (5 cycles), and 19.5 L (7 cycles). Daily Kpt/Vurea and daily CCp (peritoneal) (L/day/1.73 m2) were obtained. Results Six patients were H or HA (group 1) and 5 were LA transporters (group 2). For the group 1 patients, mean weight was 86.6 ± 13.5 kg; Kpt/Vurea was 1.68 ± 0.21 using 9.5 L, 2.03 ± 0.28 for 14.5 L ( p < 0.05 compared to 10 L), and 2.28 ± 0.28 with 19.5 L ( p < 0.05 compared to 10 L and 15 L); mean weekly CCp was 45.43 ± 7.63 L/1.73 m2 for 9.5 L ( p < 0.05 compared to 14.5 L and 19.5 L), 51.17 ± 7.07 with 14.5 L, and 54.67 ± 10.08 for 19.5 L; ultrafiltration rates were not different in the three studies. For the group 2 patients, mean weight was 74.3 ± 17.7 kg; mean weekly Kpt/Vurea was 1.68 ± 0.35 using 9.5 L, 2.10 ± 0.42 for 14.5 L ( p < 0.05 compared to 9.5 L), and 2.31 ± 0.56 for 19.5 L ( p < 0.05 compared to 9.5 L and 14.5 L); mean weekly CCp was 42.56 ± 10.64 L/1.73 m2 for 9.5 L ( p < 0.05 compared to 14.5 L and 19.5 L), 50.89 ± 12.66 for 14.5 L, and 51.94 ± 11.20 for 19.5 L; ultrafiltration was lower in the 9.5-L study than in the 14.5-L and 19.5-L studies, but was not different in the 14.5-L and 19.5-L studies. Conclusions In both H/HA and LA transporters, Kpt/Vurea and CCp rise significantly when the frequency of exchanges and total volume of dialysate are increased. Thus, the use of larger volumes of dialysate with cycling peritoneal dialysis may result in increased clearances of urea and creatinine.

The Role of Flumazenil in the Management of Patients With Acute Alteration of Mental Status in the Emergency Department

1994 ◽  
Vol 13 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Tzyh-Lih Chern ◽  
Sheng-Chuan Hu ◽  
Chen-Hsen Lee ◽  
Jou-Fang Deng
Keyword(s):  
Mental Status ◽  
Large Scale ◽  
Case Reports ◽  
Favourable Outcome ◽  
Unknown Aetiology ◽  
Time Period ◽  
Group 2 ◽  
One Year ◽  
Group 1

1 There are a few case reports which suggest that flumazenil can be used as a diagnostic tool in coma of unknown aetiology but no large scale studies have proved its efficacy and cost-effectiveness. 2 Fifty five patients with acute alteration of mental status of unknown aetiology were enrolled prospectively during a time period of one year. Flumazenil was injected intravenously in a regimen of 0.3 mg in the first minute followed by alternate 0.2 mg, 0.3 mg doses every minute until a total dose of 1 mg was given or until the patients responded. 3 Patients were divided into two groups based on their response to flumazenil: Group 1, responders and Group 2, non-responders. The hospital stay was shortened significantly and interventional procedures, such as CT of brain and endotracheal intubation, were rendered unnecessary in several patients in Group 1. The Group 1 patients had a more favourable outcome than that of Group 2. 4 We concluded that flumazenil may serve as a useful tool in diagnosis and management of carefully selected patients with acute alteration of mental status.

Abstract 738: Role of the Pulmonary Veins in Experimental Paradigms of Remodeling- Basic Science Associated Atrial Fibrillation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Masao Sakabe ◽  
Kristina Lemola ◽  
Katsuyoshi Chiba ◽  
Grigorios Katsouras ◽  
Akiko Shiroshita-Takeshita ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Rate Adaptation ◽  
Ventricular Rate ◽  
Atrial Remodeling ◽  
List Type ◽  
Ablation Therapy ◽  
Before And After ◽  
The Mean

Background : Pulmonary vein (PV) activity is crucial in some forms of clinical atrial fibrillation (AF), particularly paroxysmal lone AF. The precise importance of PVs in AF associated with structural heart disease is less clear. Some evidence suggests that PVs may be important for AF in experimentally-remodeled atrial substrates, e.g. atrial-tachycardia remodeling (ATR) and congestive heart failure (CHF)-induced structural remodeling, but contradictory findings also exist. This study assessed the role of PVs in canine remodeling-associated AF by evaluating the changes induced by PV-LA disconnection via encircling epicardial ablation. Methods: AF was induced before and after complete isolation of all PVs in dogs with: ATR induced by atrial tachypacing (400 bpm x 1 wk; with AV block and 80 bpm ventricular pacing to control ventricular rate, n=5); and CHF induced by ventricular tachypacing (VTP, 240 bpm x 2 wks, n=7). Electrophysiological measurements and AF mapping with 240 unipolar atrial electro-grams in both atria and all PVs were also obtained before and after PV isolation. Results ATR reduced atrial ERPs and ERP rate adaptation. The shortest AF cycle length (AFCL) in each ATR dog was recorded from PVs (mean 84±3 ms), but the mean AFCL in each of the PVs (range 97–103 ms) was not different from the mean AFCL at LA sites (98 –103 ms). PV ablation did not affect AF duration in ATR dogs (mean 284±265 pre- vs. 304±225 s post-ablation, P=NS), nor did it significantly alter RA or LA AFCL. In CHF dogs, ERPs and ERP rate adaptation were preserved. The shortest AFCL was recorded in PVs in 2 dogs (108,112 ms) and in the left side of Bachmann’s bundle in 3 (97–117 ms). PV ablation failed to alter AF duration in CHF dogs (mean 778±203 pre- vs. 644±206 s post-ablation), and increased AFCL in RA and LA slightly (10 –15%) but not significantly. Conclusions : Uncoupling of the PVs from the LA fails to significantly affect the AF substrate in 2 clinically-relevant animal paradigms of AF-promoting atrial remodeling. These findings suggest that in the presence of a favorable atrial substrate for AF the PVs are not needed for AF maintenance, and are consistent with clinical observations that complete PV isolation may not be essential for effective ablation therapy of all groups of AF patients.

scholarly journals A clinical study on role of caroverine in the management of tinnitus

2016 ◽  
Vol 6 (1) ◽  
pp. 176
Author(s):  
Abha Kumari ◽  
Sandeep Kumar
Keyword(s):  
Complete Relief ◽  
Sound Stimulation ◽  
Frequency Matching ◽  
Group I ◽  
Significant Difference ◽  
Before And After ◽  
Group 2 ◽  
Sensory Neural ◽  
Group 1

Background: Tinnitus is a perception of sound in the absence of sound stimulation and it continues to be a significant and costly health problem without a uniformly accepted treatment. The signals between the inner hair cells and the cochlear nerve fibres are most likely to be transmitted by glutamate. Hence, present study was undertaken to assess the role of caroverine which is a glutamate receptor antagonist in the management of sensory neural tinnitus.Methods: The present study was conducted among 50 adult patient with sensory neural tinnitus divided into two groups with 25 patients in each group. In group 1 caroverine 20 mg twice daily for a period of 90 days was administered and in group 2 placebos was given. The effect of caroverine and placebo on subjective relief and objective improvement was evaluated by using THI (Tinnitus Handicap, Inventory) scoring, Tinnitus frequency matching before and after the administration of caroverine and placebo.Results: In Group I reduction in tinnitus was seen in 16 patients (64%) in 90 days. In group II (placebo group) improvement was seen in 20% of the patient. Significant difference with respect to treatment was noted. In group 1, 8% of the patient showed complete relief from the tinnitus. 44% of the patient showed improvement below 50% whereas 12% of the patient showed improvement more than 50%.Conclusions: Carvoverine had shown a statistically significant improvement in tinnitus management. 

Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves Disease Before and After Anti-Thyroid Therapy

2020 ◽  
Vol 20 ◽  
Author(s):  
Gamze Akkuş ◽  
Yeliz Sökmen ◽  
Mehmet Yılmaz ◽  
Özkan Bekler ◽  
Oğuz Akkuş
Keyword(s):  
Treatment Group ◽  
Medical Treatment ◽  
Surgical Therapy ◽  
Graves Disease ◽  
Before And After ◽  
Euthyroid Status ◽  
Ectopic Beats ◽  
Group 2 ◽  
Electrocardiographic Parameters ◽  
Group 1

Background: We aimed prospectively investigate the laboratory and electrocardiographic parameters (hearth rate, QRS, QT, QTc, Tpe, Tpe/QTc, arrhythmia prevalance) in patients with graves disease before and after antithyroid therapy. Methods: 71 patients (48 female, 23 male), age between 18-50 (mean±SD: 36.48±12.20 ) with GD were included into the study. Patients treated with antithyroid therapy (thionamids and/or surgical therapy) to maintain euthyroid status. Patients were examined in terms of electrocardiographic parameters before and after the treatment. Results: Mean TSH, free thyroxin (fT4) and tri-iodothyrionine (fT3) levels of all patients were 0.005±0.21, 3.27± 1.81, 11.42±7.44, respectively. While 9 patients (group 2) underwent surgical therapy, had suspicious of malignant nodule or large goiter and unresponsiveness to medical treatment; the other patients (n=62, group 1) were treated with medical therapy. Patients with surgical therapy had more increased serum fT4 (p=0.045), anti-thyroglobulin value (p=0.018) and more severe graves orbitopathy (n=0.051) before treatment when compared to medical therapy group. Baseline Tpe duration and baseline Tpe/QTc ratio and frequency of supraventricular ectopic beats were found to be significantly higher in group 2 when compared to group 1 (p=0.00, p=0.005). Otherwise baseline mean heart rate, QRS duration, QTc values of both groups were similar. Although the patients became their euthyroid status, group 2 patients had still suffered from more sustained supraventricular ectopics beats than group 1. Conclusion: Distinct from medical treatment group, surgical treatment group with euthyroidism at least 3 months had still suffered from an arrhythmia (Tpe, Tpe/QTc, supraventricular and ventricular ectopic beats).

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