Bryce Alexander

Wine and Cardiovascular Health: A Comprehensive Review

Alcoholic beverages have been consumed for thousands of years, attracting great human interest for social, personal, and religious occasions. In addition, they have long been debated to confer cardioprotective benefits. The French Paradox is an observation of a low prevalence of ischemic heart disease, with high intakes of saturated fat, a phenomenon accredited to the consumption of red wine. Although many epidemiological investigations have supported this view, others have attributed it to beer or spirits, with many suggesting that the drink type is not important. Although excessive consumption of alcoholic beverages is commonly regarded to be detrimental to cardiovascular health, there is a debate as to whether light-to-moderate intake is cardioprotective. Although there is extensive epidemiological support for this drinking pattern, a consensus has not been reached. On the basis of published work, we describe the composition of wine and the effects of constituent polyphenols on chronic cardiovascular diseases.

The impact of advanced Interatrial block on new-onset atrial fibrillation following TAVR procedure

Article history: Received 27 June 2016 Accepted 4 August 2016 Available online 04 August 2016 quickly becoming a go-to procedure for patients with AS who are deemed too high risk for a traditional AVR, and with a considerable incidence of new-onset AF following TAVR, the identification of advanced IAB as a predictor of new-onset AF would be of great value to clinicians managing this population. We conducted a retrospective study of patients who underwent a

Reverse atrial electrical remodeling induced by cardiac resynchronization therapy

PURPOSE Cardiac resynchronization therapy (CRT) has been shown to improve left atrial function; however the effect on reverse electrical remodeling has been poorly evaluated. We hypothesized that CRT might induce reverse atrial electrical remodeling manifesting in the surface ECG as a shortening in P-wave duration. METHODS Patients with CRT and more than 92% biventricular pacing at minimum follow-up of 1 year were included in the analysis. Those with prior history of atrial fibrillation (AF) were excluded. Data were recorded for clinical, echocardiographic and ECG variables prior to implant and at least 12 months post implantation. Semiautomatic calipers and scanned ECGs at 300 DPI maximized × 8 were used to measure P-wave duration and diagnose advanced interatrial block (aIAB) during sinus rhythm. The occurrence of AF was assessed through analyses of intracardiac electrograms and clinical presentations. RESULTS 41 patients were included in the study with mean age of 67.4 ±9.6 years, 71% were male, left atrial diameter 41.1 ± 8.5 mm and LV EF 28.5 ± 6.5%. Over a mean follow up of 55 months, a significant reduction in P-wave duration (142.7 ms vs. 133.1 ms; p < 0.001) was noted. The presence of aIAB was significantly reduced (36% vs. 17%; p = 0.03). The incidence of new onset AF was 36%. Time to AF onset after CRT implantation was not influenced by a reduction in P-wave duration. CONCLUSION CRT induces atrial reverse electrical remodeling manifested as a reduction in P-wave duration. Larger studies are needed to determine the impact on AF incidence after CRT implantation.

Response by Haseeb et al to Letter Regarding Article, “Wine and Cardiovascular Health: A Comprehensive Review”

We thank Dr Thornton for his interest in our article, where we reviewed the composition of wine, its risks and benefits of consumption, and presented an in-depth population-based analysis of studies discussing wine’s cardioprotective potential, with comparisons to other alcoholic beverages.1 We read his insightful response with interest and welcome the opportunity for a response. We concur with Dr Thornton that potassium in wine is of nutritional and cardioprotective significance. Potassium is the most abundant mineral in grapes, and is primarily responsible for regulating the pH and acidity of must and wine. During vinification, potassium, along with tartaric acid, chemically adjust …

Electrocardiographic interference by a sacral neuromodulation device

• Extra-cardiac electrical stimulators are a growing treatment modality and the pulses delivered by these devices may create artifacts in the ECG.

Progressive interatrial block associated with atrial fibrillation in a patient with hypertrophic cardiomyopathy.

Progressive interatrial block is a clinically significant condition that has previously been reported in various patient populations. It is a manifestation of progressive fibrosis affecting the Bachmann region. This report presents a case of progressive interatrial block associated with atrial fibrillation in the context of hypertrophic cardiomyopathy.

What's in wine? A clinician's perspective,

Alcoholic beverages, specifically wine, have been consumed for many years. Wine is postulated to play an important role in the improvement of cardiovascular risk factors. Most epidemiological studies have found sustained consumption at light-to-moderate amounts to increase HDL cholesterol, reduce platelet aggregation, and promote fibrinolysis. Wine consumption has been inversely associated with ischemic heart disease, and the alcohol-blood pressure association, in most studies, follows a J-shaped curve. These outcomes have been attributed to the molecular constituents of wine, namely ethanol and polyphenols. Due to the continued interest in wine as a biological beverage, we review the chemistry of wine as clinicians, including its chemical composition, viticulture and enological practices, and other chemical factors that influence the bioactive components of wine. We also outline the biological effects of wine components and directions for future research.

Exceptional Brugada Phenocopies

Abstract Some Brugada phenocopies have been only occasionally reported or reported only once. In many cases, the lack of systematic analysis on a given condition does not allow determination of the prevalence of the Brugada ECG pattern. Ongoing research helps determine how frequently ionic channel dysfunction will manifest with a Brugada ECG pattern (i.e., hyperkalemia). In the meantime, we propose to term those cases that have been reported very infrequently as “Exceptional Brugada Phenocopies.”

Interatrial block predicts atrial fibrillation in patients with carotid and coronary artery disease

Background Interatrial block (IAB) has been previously shown to predict atrial fibrillation (AF) in cardiac populations. This study sought to evaluate the relationship between IAB and new-onset AF in a population of patients undergoing clinically indicated coronary angiography who received carotid ultrasonography. Methods A population of 355 subjects undergoing coronary angiography and carotid ultrasound were retrospectively studied. Common carotid artery (CCA) far-wall intima-media thickness (CIMT), and total carotid plaque area were measured. Coronary artery disease was measured by angiography and IAB by electrocardiograph (ECG). Results The mean population age was 64.4 years, 70.4% male, mean BMI 29.9 kg/m2. IAB was a predictor of new-onset AF (OR =2.40, 95% CI: 1.33-4.29; P=0.003). There was a significant difference in AF free survival time between patients with IAB and without IAB via Cox proportional hazard analysis [52.9 months (95% CI: 47.1-58.7 months) vs. 62.6 months (95% CI: 58.8-66.5 months); P=0.006]. Patients with IAB had a significantly greater CIMT (0.883±0.193 vs. 0.829±0.192 mm; P=0.013) and a higher prevalence of significant (>70%) right coronary artery lesions than patients without (45.8% vs. 34.4%; P=0.026). Significant predictors of IAB on multivariate analysis were BMI ≥30 kg/m2 (OR =3.14, 95% CI: 1.14-6.71, P=0.003), male sex (OR =1.78, 95% CI: 1.05-3.03, P=0.034), increased mean CIMT (per 0.1 mm increase) (OR =1.75, 95% CI: 1.00-3.07, P=0.050) and increased age (per 10-year increase) (OR =1.46, 95% CI: 1.14-1.88, P=0.003). Conclusions IAB is a predictor of new-onset AF in patients with carotid and coronary artery disease. Both carotid and coronary artery disease are associated with a higher prevalence of IAB.

Reading habits and preferences of year 1–4 medical students in the mobile-device era

Strong reading habits are key to developing the medical expertise and the critical appraisal skills necessary for practice. At our institution, medicine spans 4 years with years 1 and 2 largely being classroom based, and years 3 and 4 largely consisting of clinical clerkships. Ideally, students should build familiarity with multiple sources of literature including educational materials, point-of-care (POC) tools and scientific papers to become versatile, lifelong learners. Recent advances in educational technology and mobile devices have provided new opportunities for learning, and thus may have changed how the modern learner reads.