Although atrial fibrillation (AF) is the most common cardiac arrhythmia, there is variation in practice with regard to the management of acute AF among the hospitals and even within the same hospital in Oman. This variation likely reflects a lack of high-quality evidence. Standard guidelines and textbooks do not offer clear evidence-based direction for physicians to guide the management of acute AF. Particularly controversial is the issue of using rhythm control or rate control. This stimulated Oman Heart Association (OHA) to issue a simplified protocol for the management of acute AF to be applied by the entire cardiac caregivers all over the country. The priorities for acute management of AF include stabilizing the patient's hemodynamic status, symptom control, treatment of the underlying and precipitating cause, and more importantly protecting the brain.

Heart Rhythm

10.1097/hpc.0000000000000015

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Left ventricular apical hypertrophy (Yamaguchi disease)

European Heart Journal - Case Reports (2021)

Hatim Al Lawati Marwa Al Habsi Adil B Al Riyami

Abstract Apical Hypertrophic Cardiomyopathy (Ap-HCM) also known as Yamaguchi Disease is characterized by limited involvement of the left ventricular (LV) apex. It can present with typical ischaemic chest pain, dyspnoea and arrhythmias. We report the case of patient with ischaemic chest pain who was diagnosed with Ap-HCM at the time of coronary angiography. We share representative images from his cardiac evaluation.

Apex (geometry)

Ischaemic heart disease

10.1093/ehjcr/ytab330

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2012 Oman Heart Association Simplified Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Critical Pathways in Cardiology A Journal of Evidence-Based Medicine (2012)

Mohammed H. El-Deeb Abdullah M. Al Riyami Abdullah Amour Riyami Kadhim Sulaiman Rashid Shahrabani

Although current practice guidelines provide an evidence-based approach to the management of acute coronary syndromes, application of the evidence by individual physicians has been suboptimal. This gap between comprehensive guidelines and actual practice stimulated Oman Heart Association to issue a simplified series for the management of the common cardiac abnormalities to be applied by the entire cardiac caregivers all over the country. This simplified approach for the management of non–ST-elevation acute coronary syndrome provides a practical and systematic means to implement evidence-based medicine into clinical practice.

Unstable angina

ST elevation

Clinical Practice

Evidence-Based Medicine

10.1097/hpc.0b013e31825ac653

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Percutaneous Septal Reduction Therapy in a Patient with Severely Symptomatic Hypertrophic Obstructive Cardiomyopathy

Sultan Qaboos University medical journal (2022)

Hatim Al Lawati Sunil Nadar Adil B Al Riyami

NONE

10.18295/squmj.3.2022.020

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Unexpected Entrapment of Caravel Microcatheter in Percutaneous Chronic Total Coronary Intervention

Sultan Qaboos University medical journal (2024)

A. S. Muhammad Adil B Al Riyami Muhammad A Khatri Hafidh Ba Omar

NONE

Entrapment

10.18295/squmj.3.2024.027

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Early discharge after low-risk ST-eletavation myocardial infarction and risk of adverse clinical ouctomes. validity and applicability of the zwolle risk score in a resource-restricted health system

European Heart Journal (2023)

Hatim Al Lawati Sunil Nadar Motasim Badri Metab Al Ghafri Adil B Al Riyami

Abstract Background/Introduction A Low Zwolle Risk Score (ZRS) identifies patients suitable for early hospital discharge after primary percutaneous coronary intervention (PPCI) without subsequent increase in post-discharge major adverse events (MAE).1 Data supporting this approach in resource-limited health care systems is sparse. This is particularly relevant in locales where the primary health care infrastructure is not efficiently geared towards managing patients with cardiovascular diseases and where the risk of MAE approaches 4% in the first-year post discharge.2. Purpose We aim to validate the ZRS in our population and correlate it with MAE. We intend to examine the rates of the individual adverse events at 1-month and 6-months post discharge and identify any potential gaps in management during the short hospital stay. Methods This was a retrospective analysis from the local PCI Registry at our Hospital. It included patients from 2014-2020 who were > 18 years of age who underwent PPCI for ST-elevation myocardial infarction. The rates of MAE were examined at 1-month and 6-months post-discharge. These were compared against patients with high ZRS (>4) from the same registry. Results A total of 570 patients were included in the analysis; 406 (71.2%) had a low ZRS of <4 and the remaining 164 (28.8%) were high risk (ZRS >4). The low ZRS group were younger (52.8 + 11.7 yrs. vs. 64.7 + 12.4 yrs., p<0.001), less likely to have CKD (6.4% vs. 17.7%, p<0.001) and previous CABG (0.5% vs. 2.4%, p=0.03). The median total length of hospital stay was 2 days (IQR 1-3) and significantly shorter than that in the high ZRS group of up to 7 days (p<0.001). The low-risk group were less likely to have an infarct culprit lesion in the LM (0.5% vs. 4.9%, p<0.001) or the LAD (42.6% vs. 68.3%. p<0.001). They were also less likely to have multivessel disease (32.8% vs. 47.6%, p=0.001). When comparing outcomes between the Low ZRS and high ZRS groups, the overall event rate at 1-month was 11.8% vs.37.1% (p<0.001), respectively and 14.0% vs. 45.7% (p<0.001) at 6-months, respectively. Interestingly, 1 in 20 patients at 1-month and 1 in 15 patients at 6-months post-discharge were re-hospitalized for decompensated heart failure. A ZRS of <4 was associated with lower procedural (0.4% vs. 3%, p=0.01), in-hospital (2.4% vs. 14.0%, p<0.001), and 6-month mortality (0.24% vs. 1.8%, p<0.001). A ZRS of >4 was an independent predictor of increased mortality at 6 months (OR 1.37, 95% CI 1.275-1.500, p<0.001] Conclusion(s) Even within a resource-restricted health system, the ZRS can identify patients safe for early discharge with a low event rate at 1- and 6-months post-discharge. Additionally, a low ZRS was associated with low mortality. Our study captured more MAE than previous reports. There is a potential for optimization of medical therapy during the short hospital stay to minimize risk of adverse events, especially re-hospitalizations for heart failure.Baseline CharacteristicsMain Study Outcomes

10.1093/eurheartj/ehad655.1404

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