Reza Mollazadeh

Rationale: Mobile health (mHealth) offers a modern educational approach for delivering behavioural interventions and enhancing healthcare professionals' knowledge, particularly through technology‐enhanced tools like clinical decision support systems (CDSS). Given the complexity of AF thromboprophylaxis—balancing thromboembolic/bleeding risk, comorbidities, considering lab data, and drug interactions such tools are critical, as evidence‐based thromboprophylaxis reduces both stroke risk and mortality. Aims and Objectives: This study aimed to examine changes in clinical pharmacy and cardiology residents' performance on case‐based multiple‐choice questions (MCQs) related to AF thromboprophylaxis and their self‐reported confidence in their responses following exposure to the ACAFiB CDSS. Methods: Using a quasi‑experimental pre‑test/post‑test design, the ACAFiB web‑based CDSS was assessed for its potential to assist in improving learning and confidence. Fifteen complex clinical scenarios in multiple‑choice format were used for the pre‑test, and another 15 thematically similar scenarios were used for the post‑test. Thirty‑one residents participated in two exams, 1 week apart. During the pre‑test, participants could search freely, whereas in the post‑test, they were restricted to using only ACAFiB. They also reported their confidence level for each response. Results: Test scores increased from 7.06 ± 2.08 to 10.74 ± 2.11 ( p < 0.001; effect size: 1.71), and confidence‐weighted scores increased from 0.71 ± 10.05 to 17.90 ± 10.52 ( p < 0.001; effect size: 1.43) following ACAFiB exposure. These findings indicate improved performance on the case‐based assessment and higher confidence‐weighted scores after use of the CDSS. No significant differences were observed between residents based on specialty, residency entry year, or gender. Conclusion: In conclusion, this study suggests that the use of the ACAFiB CDSS is associated with improvements in residents' clinical decision‐making performance and confidence in managing thromboprophylaxis for AF patients. Future studies should evaluate the tool's effectiveness using patient‑centred outcomes.

Background: Leadless pacemakers (LPs) are developed to avoid pocket‐ and lead‐related complications of transvenous pacing systems, but direct comparative data between two single chamber LP, namely Micra VR and Aveir VR are scarce. Methods: A systematic review and meta‐analysis of studies directly comparing Micra VR and Aveir VR was performed. PubMed, Embase, and Scopus were searched through November 2025. Eligible studies reported electrical performance, procedural metrics, or periprocedural complications. Results: Four observational studies, including 757 patients (363 Aveir, 394 Micra), met the inclusion criteria, with follow‐up of 1–6 months. At implantation, Aveir showed slightly higher pacing thresholds (mean difference (MD) 0.18 V; 95% CI 0.09–0.26), while impedance and R‐wave amplitude were similar. In follow‐up, pacing thresholds showed no significant difference between devices, whereas Micra demonstrated higher R‐wave amplitudes (MD −1.18 mV; 95% CI −2.29 to −0.07). Fluoroscopy time was longer with Aveir (MD 2.89 min; 95% CI 0.69–5.08), but total procedure duration did not differ significantly. Rates of device dislodgement, pericardial effusion/tamponade, and overall periprocedural complications were low and not statistically different between the two systems. Conclusion: Micra VR and Aveir VR demonstrate generally comparable short‐term electrical performance, procedural efficacy, and safety. Minor differences in thresholds, sensing, and fluoroscopy time are likely indicative of design and workflow characteristics. Larger, well‐controlled randomized studies with extended follow‐up periods are necessary to establish long‐term performance.

Syncope is defined as a transient loss of consciousness, with vasovagal syncope (VVS) being the most common cause. Although VVS episodes are typically self-limiting, they can significantly impact patients’ quality of life. The syncope functional status questionnaire (SFSQ) is an internationally standardized tool designed to assess two major health dimensions: the physical and psychosocial domains. This study aimed to translate and culturally adapt the SFSQ into Persian and assess its validity and reliability. This study was conducted in Tehran, Iran, between October 2022 and January 2023. It consisted of three phases: first, the translation and cultural adaptation of the questionnaire into Persian; second, an assessment of the comprehensibility of the pre-final version through a pilot study involving 50 individuals; and third, an evaluation of the reliability and validity of the final translated version. We assessed test-retest reliability, content validity, and convergent validity by examining the correlations between the dimensions of the translated SFSQ and other relevant measures. Among 50 patients, 26 were women, and 24 were men. The mean age of the participants was 26.5±5.5 years. Test-retest reliability was good, with a Cronbach’s alpha coefficient of 0.84. Both face validity and content validity index (CVI) were deemed acceptable, with a misunderstanding index of 18% (below the 20% significance threshold) and a CVI of 92% (above the 88% significance threshold for all questions). The Persian version of the SFSQ was found to be a reliable and valid tool for data collection in patients with syncope. This instrument represents a significant step toward standardizing syncope-related research.

Background: Pulsed field ablation (PFA) is an emerging non‐thermal catheter ablation (CA) modality for the treatment of atrial fibrillation (AF), PFA has shown a relatively similar success rate but offers improved safety compared to thermal approaches such as radiofrequency ablation (RFA) and cryoballoon ablation (Cryo). Although its clinical benefits are well established, comparative data on its economic impact remain limited. Objective: This systematic review aimed to compare the cost profiles of PFA versus thermal ablation strategies in patients with AF. Methods: We systematically searched PubMed, Embase, and Scopus through April 2025 for studies reporting cost analyses comparing PFA with RFA or Cryo. Extracted data included per‐patient cost, procedural time, and, when available, cost‐effectiveness metrics such as quality‐adjusted life years (QALYs) and net monetary benefit (NMB). Results: Four studies met the inclusion criteria. Despite variability in health care settings and costing approaches, three of the four studies demonstrated that PFA was cost‐saving compared to thermal ablation, with per‐patient differences ranging from $520 to $2387. One study reported higher costs for PFA, with an excess of $2447 compared to Cryo. PFA was consistently associated with shorter procedural times, suggesting potential efficiency gains for high‐volume centers. Only one study reported a formal cost‐effectiveness analysis, in which PFA demonstrated both lower total costs and higher QALYs, resulting in an NMB of $2947 at a willingness‐to‐pay threshold of $100,000 per QALY. Conclusion: PFA shows a favorable cost profile compared to RFA and Cryo, driven by reduced procedural time and lower long‐term costs.

Introduction: Lead-related infective endocarditis is a rare complication with a high mortality rate that needs to be addressed immediately. In most cases, surgery is mandatory in addition to medical treatment. Alternative techniques to conventional cardiopulmonary bypass have been developed to reduce the inflammatory response and post-operative complications. Case presentation: A 29-year-old male patient with a dual-chamber implantable cardioverter defibrillator presented to our hospital with infective endocarditis. Early evaluation of the patient revealed a large mobile 6*2 cm vegetation attached to the leads and tricuspid valve and the right atrium. Due to large size of the vegetation, the patient got prepared for surgical removal of the vegetation. The patient underwent right heart bypass with cannulation of the inferior and superior vena cava and the pulmonary artery. Discussion: The inflammatory response subsequent to cardiopulmonary bypass plays an important role in postoperative complications such as pulmonary complication including transient hypoxemia or even more severe complication like acute respiratory distress syndrome. Additionally, the ascending aorta manipulation may result in postoperative cerebral atheroembolism and stroke. In selected patients, right heart bypass is a better option, as cardioplegic arrest is not needed in this technique, and a less post-operative inflammatory response is expected due to the absence of long tubes, an oxygenator, and aortic clamping. Conclusion: Right heart bypass could be a less complicated, safer, and cost-benefit alternative to conventional cardiopulmonary bypass in the case of right-sided heart problems. This technique allows effective decompression of the right heart and adequate oxygenation without postoperative complications, usually seen in routine cardiopulmonary bypass.

Background: Cardiac implantable electronic device (CIED) implantation is on the rise, accompanied by an increase in its inevitable complications such as different types of CIED infections that require further therapy and potential device extraction. Ensuring efficacy and safety remains paramount in transvenous lead extraction (TLE), given the complex nature of the procedure. The purpose of this study is to assess the outcomes of relatively low-cost mechanical TLE, including mid-term clinical follow-up, and to develop a predictive model for post-TLE survival. This study included all consecutive patients admitted for TLE at two tertiary medical centers between 2016 and 2021. Baseline characteristics, TLE procedure details complications occurring during and/or after the procedure and follow-up outcomes were collected. Results: During the 5-year period, 100 consecutive patients underwent TLE. The mean age of the subjects was 61 ± 3 years. The average time from lead implantation to TLE was 69.34 ± 9.36 months, with a total of 216 leads extracted. The most common indication for TLE was infection observed in 87% of subjects with pocket infection seen in the majority (84%). Complete clinical success was achieved in 98% of patients, with major complications occurred in 5% of cases and only one case of peri-procedural death. Proposed experimental model showed that near 50% of the patients will live less than 73.29 months. Conclusion: TLE demonstrated a high level of safety with low mortality and morbidity rates. Using low cost widely available mechanical tools is useful for treating CIED-related infections.

Current arrhythmia therapies such as ion channel blockers, catheter ablation, or implantable cardioverter defibrillators have limitations and side effects, and given the proarrhythmic risk associated with conventional, ion channel-targeted anti-arrhythmic drug therapies, a new approach to arrhythmias may be warranted. Measuring and adjusting the level of specific ions that impact heart rhythm can be a simple and low-complication strategy for preventing or treating specific arrhythmias. In addition, new medicines targeting these ions may effectively treat arrhythmias. Numerous studies have shown that intracellular and extracellular zinc concentrations impact the heart's electrical activity. Zinc has been observed to affect cardiac rhythm through a range of mechanisms. These mechanisms encompass the modulation of sodium, calcium, and potassium ion channels, as well as the influence on beta-adrenergic receptors and the enzyme adenylate cyclase. Moreover, zinc can either counteract or induce oxidative stress, hinder calmodulin or the enzyme Ca (2+)/calmodulin-dependent protein kinase II (CaMKII), regulate cellular ATP levels, affect the processes of aging and autophagy, influence calcium ryanodine receptors, and control cellular inflammation. Additionally, zinc has been implicated in the modulation of circadian rhythm. In all the aforementioned cases, the effect of zinc on heart rhythm is largely influenced by its intracellular and extracellular concentrations. Optimal zinc levels are essential for maintaining a normal heart rhythm, while imbalances-whether deficiencies or excesses-can disrupt electrical activity and contribute to arrhythmias