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The presence of atrioventricular accessory pathway can cause heart failure due to the disorder of cardiac depolarization sequence: a case report
Babak Payami, Shirin Azizidoost , Naem Mansouri ,
Volume 81, Issue 10 (January 2024)
Abstract
Background: Wolff-Parkinson-White syndrome is a rare but well-known disease that predisposes a person to cardiac arrhythmias. But sometimes this syndrome is accompanied by heart failure in the affected person. Several causes have been proposed for this complication including recurrent or incessant tachyarrhythmias that are frequently found in symptomatic (especially children) Wolf-Parkinson-White syndrome patients causing heart dysfunction and dilation and dilated cardiomyopathy, and also pre-excitation-related dyssynchrony leading to progressive ventricular remodeling and dilation. In this report, a patient is introduced who has improved his heart failure by radio-frequency ablation of free wall type of this syndrome.
Case Presentation: A 35-year-old man who had a history of Wolff-Parkinson-White syndrome from 8 years ago and suffered from dilatation and reduced left ventricular ejection fraction in recent years was presented with a pre-excited atrial fibrillation attack at the emergency department. The initial surface ECG showed positive delta wave in all precordial leads and negative QRS complexes in interior leads with QRS duration of about 200 ms. He had undergone electrophysiology study and ablation at the left postero-lateral accessory pathway. After ablation of accessory pathway within the months (from November 2022 until June 2023), left ventricular function was gradually improved and the symptoms of the patient's shortness of breath were also decreased.
Conclusion: The existence of heart failure in patients with Wolff-Parkinson-White syndrome can be due to various reasons including the presence of an accessory pathway and the dyssynchrony of intraventricular contraction which is caused by premature excitation of the connected part of the left ventricle by accessory atrioventricular pathway. Although in order to rule out the possibility of the incidental association of the accessory pathway with primary dilated cardiomyopathy and to investigate the segmental dyskinesia, it is necessary to perform diagnostic measures such as echocardiography and cardiac computerized tomography and magnetic resonance imaging, ablation of such accessory pathway not only controls arrhythmic attacks but also leads to the improvement of the left ventricular systolic function even in a middle age patient.

Study of the relationship between acidosis and coagulation disorders in patients undergoing laparotomy admitted to the intensive care unit
Reza Baghbanian, Shirin Azizidoost , Kamran Mahmoodi , Mahbobeh Rashidi , Golshan Mirmomeni, Sina Ganji Nataj ,
Volume 82, Issue 12 (March 2025)
Abstract
Background: Coagulopathy is one of the most common causes of mortality in the intensive care unit. This study was designed and implemented to investigate the relationship between acidosis and coagulation disorders in patients undergoing laparotomy in the intensive care unit.
Methods: This retrospective study reviewed the files of 121 patients undergoing laparotomy in the intensive care unit of Imam Khomeini Hospital of Ahvaz during 2024. Demographic and clinical records and blood test results were extracted to measure parameters related to acidosis and coagulation tests. Then, the rates of coagulopathy, thrombocytopenia, acidosis, and patient outcome were calculated. The data obtained were analyzed using SPSS version 27 software.
Results: Most patients studied were male (72 (59.5%)) with a mean age of 54.18±21.1 years and a mean length of stay of 6.78±5.87 days. Hypertension (34 (28.1%)) was the most important comorbidity and peritonitis (54 (44.6%)) was the most important cause of hospitalization. The incidence rates of coagulopathy, thrombocytopenia, and acidosis were reported to be 29 (24%), 27 (22.3%) and 115 (95%), respectively. A total of 44 (36.5%) patients died during the study period. Although the rates of coagulopathy and thrombocytopenia were higher in patients with acidosis, these differences were not significant (P<0.05). The mortality rates among those without thrombocytopenia, mild, moderate, and severe thrombocytopenia were reported as 27 (28.7%), 4 (33.3%), 9 (81.1%), and 4 (100%), respectively, showing a significant difference (P=0.001). The mean pH in deceased patients was significantly lower than in others (0.13±7.19 vs. 0.88±7.25; P=0.005). The mortality rate in patients with coagulopathy was also significantly higher than in others (20 (69%) vs.24 (26.4%); P=0.000).
Conclusion: The incidence of acidosis and coagulation disorders in patients undergoing laparotomy and admitted to the intensive care unit is significant and is linked to poorer outcomes for these patients. However, acidosis was not found to be an independent risk factor for coagulation disorders in this population. Further research is necessary to confirm or refute these findings.

Investigation the frequency and causes of readmission in patients with cardiovascular diseases
Somayeh Abbaspour , Hassan Karimi, Maryam Farzaneh , Zahra Karimi , Shirin Azizidoost ,
Volume 83, Issue 7 (October 2025)
Abstract
Background: The duration of hospitalization of patients is considered an important indicator in health resource management and patient evaluation. This study investigated the frequency and causes of readmission in cardiovascular patients
Methods: This was a retrospective study of 105 patients with cardiovascular diseases referred to Imam Khomeini Hospital in Ahvaz who were readmitted from April 2024 until August 2024 within 30 days after discharge due to recurrence of symptoms. Demographic (including age and gender) and clinical information (including duration of hospitalization, regular medication use, regular physician visits, disease diagnosis and dietary adherence) of the patients was extracted from electronic records using a researcher-made checklist.
Results: From 105 patients, 43 (41%) were admitted in the first trimester and 62 (59%) in the second trimester. The mean age of patients in the first trimester was higher than in the second trimester with a statistically significant association with readmission (P=0.038). Most patients were male and their number was higher in the second trimester than in the first trimester and a statistically significant association was observed between the gender of patients with readmission in the first trimester compared to the second trimester (P=0.015). 72 patients with acute coronary syndrome (68.6%) and 33 patients with heart failure (31.4%) were readmitted. The mean length of stay in the first trimester was 1.6 ± 1.15 days and 2.9 ± 2.7 days in the second trimester. A significant association was observed between the duration of hospitalization and readmission (P=0.003). However, no association was observed between regular medication use and regular physician visits in readmitted patients. However, a significant association was observed between dietary adherence in readmitted patients (P=0.045).
Conclusion: Readmission of cardiovascular patients follows a seasonal pattern and is associated with factors such as age, sex, length of stay, and dietary adherence. Routine disease management measures are not sufficient to counteract these effects, and targeted educational programs are necessary at the threshold of high-risk periods.
 

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