Objective. J point and coved ST elevation in right precordial leads (not produced by coronary artery disease) are still a matter of challenge, especially when resembling Brugada patients. This clinical entity, among asymptomatic individuals with no family history of sudden cardiac death, would be reported in some severely ill patients before ventricular fibrillation. This study investigated the relationship between the electrocardiograms with demographic and laboratory data and also analyzed their association with mortality rate among patients with methanol poisoning. Methods. The sample consisted of 356 patients who were hospitalized with a diagnosis of methanol poisoning in Faghihi and Namazi Hospitals in Shiraz, Southern Iran, in March and April 2020. In this period, a major outbreak of methanol poisoning had occurred in this area. Furthermore, the study used the data on any recorded complications or mortality during hospital course. Results. The ECG (BrP) was observed in a total of 20 (5.6%) patients. Its presence was associated with increased mortality, Glasgow coma scale score <3, and blood sugar levels and was inversely associated with PH, O₂ saturation, and calcium levels ( ). Conclusions. This study found that certain ECG patterns and laboratory data can be used as prognostic factors of morbidity and mortality in patients with methanol intoxication. Electrocardiography machines are widely available tools, which can be easily used for risk stratification based on the presence of Brugada approximating electrocardiograms among patients with methanol intoxication.

Key Clinical Message: Cor triatriatum is a rare congenital heart abnormality in which a membrane separates the left atrium (LA; sinister) or the right atrium (dexter) into two compartments. It is also a long‐forgotten cause of atrial fibrillation (AF) and substantially higher rates of blood stagnation, particularly proximal to the additional septum in the LA. In this case report, we faced a CHA2DS2‐VASc score of 1 in patients with non‐valvular AF due to Cor triatriatum sinister (CTS). The decision to start anticoagulants in this particular case was controversial, so we reviewed the literature to assess and address it. We present our case and discuss the indication of anticoagulants in this unique clinical scenario, accompanied by a literature review. Facing this dilemma of starting anticoagulants in special cases of CTS and AF should be individualized and need more investigation. However, till this moment, based on similar reports, it seems to be rational to consider CTS Per se as an additional risk stratification marker beyond the CHA2DS2‐VASc score start anticoagulant until the surgical resection. Considering CTS as the sole indication of anticoagulant in patients with normal sinus rhythm is a complex matter that needs further investigation.

Background: Neurally mediated syncope (NMS) is the primary cause of temporary and self‐limiting loss of consciousness. The tilt table test (TTT) has been consistently employed as a supplementary diagnostic tool for syncope evaluation. However, TTT requires specialized equipment, which is lacking in several emergency room and clinic environments. We hypothesized that patients susceptible to NMS may have higher parasympathetic tone. Thus, this study investigates the correlation between PR interval and Herat rate variability parameters as indicators of parasympathetic tone and TTT results.Methods: We included 213 patients referred to our cardiology clinic with an impression of NMS in 2022 and 2023. Data was retrospectively collected from 24‐h ambulatory electrocardiographic monitoring recordings, TTT results, and patients' history and physical examination records.Results: The analysis of the PR interval revealed a mean duration of 155 ms (95% CI: 148.61, 161.39) in negative TTT patients and 164.21 ms (95% CI: 158.44, 169.97) in positive TTT patients, indicating a statistically significant difference between two groups (p = 0.035). We also found that patients with a PR interval duration exceeding 160 ms demonstrated a significantly higher prevalence of positive TTT compared to those with a PR interval duration of less than 160 ms (p < 0.001, OR: 3.911, 95% CI: 2.143, 7.140).Conclusions: Our study suggests a PR interval longer than 160 milliseconds as a valuable tool for predicting TTT results and identifying patients at higher risk of NMS.

Objectives: When tricuspid valve repair is unfeasible due to extensive damage or a complex congenital malformation, surgeons consider tricuspid valve replacement (TVR). However, it is still controversial and challenging to choose the best substitute. We aimed to introduce the innovative intraoperatively valve construction using the native right atrial appendage (RAA) tissue for TVR and investigate the short-term outcomes. Methods: This study recruited paediatric and adult patients with unrepairable severe tricuspid regurgitation (TR) who needed TVR. The patient’s RAA tissue was harvested and used to reconstruct a native bileaflet valve during surgery. Transthoracic echocardiography was conducted before operation, 6, and 12 months after surgery. Results: The procedure was successfully executed on 3 patients with valve destruction as a result of infective endocarditis, and 3 patients who had severe TR due to congenital anomalies. There was no mortality or related morbidity. All the constructed valves had proper function with no complications after the surgery. Follow-up echocardiographic studies showed stable and satisfactory valve function with no regurgitation or significant stenosis. Conclusions: The novel tricuspid valve operation using native RAA tissue demonstrates promising short-term results. Further studies with larger cohorts and longer follow-ups are required to confirm the technique’s reliability and long-term effectiveness.

Background: Orlistat is a potent lipase inhibitor utilized as a preventive agent for obesity and fat absorption control. Existing literature presents conflicting findings regarding its impact on lipid parameters. Methods: This systematic review followed the PRISMA guidelines and was registered in PROSPERO (ID: CRD42024550889). A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Register of Controlled Trials was conducted for studies published before January 19, 2025. Eligible studies included randomized controlled trials (RCTs) evaluating orlistat in adults (≥ 18 years) with dyslipidemia. Furthermore, the Grading of Recommendations, Assessment, Development, and Evaluations assessment tool was employed to analyze the certainty of evidence or each outcome. Results: A total number of 1369 participants, with 682 in treatment and 687 in control categories, were included in our study. Orlistat reduced body mass index (BMI) (SMD [95% CI]: −0.30 [‐0.58, −0.03], p value (heterogeneity) = 0.026), and also it was associated with a decrease in high‐density lipoprotein cholesterol (SMD (95% CI): −0.31 [‐0.48, −0.13], p value (heterogeneity) = 0.436). Changes in waist circumference (WC) and triglycerides (TGs) did not reach statistical significance in the primary analysis (WC: SMD [95% CI] −0.1562 [‐0.3138; 0.0015], I ² = 0.0%, p ‐value (heterogeneity) = 0.7572; TG: SMD [95% CI] −0.1668 [‐0.7979; 0.4642], I ² = 97.7% p value (heterogeneity) < 0.0001); however, after publication‐bias adjustment using the trim‐and‐fill sensitivity analysis, meaningful reductions were discovered for WC (SMD (%95CI): −0.1712 [‐0.3248; −0.0176], I ² = 0.0%, p value (heterogeneity) = 0.7696) and TG (SMD (%95CI): −0.8900 [‐1.6619; −0.1181], I ² = 97.9%, p value (heterogeneity) < 0.0001). The secondary analysis demonstrated that follow‐up duration accounted for 30% of TG heterogeneity, suggesting a small but significant decline in orlistat’s TG‐lowering effect over time (slope: −0.1239; 95% CI: −0.2355, −0.0123; p value = 0.0295). No significant changes were observed in other parameters of the study. Besides, gastrointestinal issues were the most frequently reported adverse events among the studies. Conclusion: Our findings suggest that orlistat meaningfully reduces BMI but is associated with decreased HDL‐C, which may be undesirable given HDL‐C’s protective role in cardiovascular health. Evidence for reductions in TG and WC is uncertain: the primary meta‐analysis showed no statistically significant effects, whereas trim‐and‐fill sensitivity analysis suggested potential reductions. No significant short‐term impact on TG was observed, though a modest reduction may emerge with prolonged use.