Ardian Rizal

• Doctor of Medicine
• Cardiac electrophysiologist at University of Brawijaya

Background: Torsade de pointes (TdP) and ventricular fibrillation can cause rapid mortality. The etiological cause the ventricular arrhythmia must be detected and treated early, especially in the ER. Objective: We report a patient with severe hypokalemia and TdP following the administration of Amiodarone in QT-interval prolongation Case Report: A 3...

Background: Permanent right ventricular (RV) pacing is a standard for high-grade atrioventricular (AV) block treatment. However, it may result in left ventricular (LV) dilatation, systolic dysfunction, and heart failure (HF) as a consequence of ventricular dyssynchrony and an abnormal myocardial contraction pattern. Pacing-induced cardiomyopathy (P...

Arrhythmia, a heart rhythm disorder, remains a serious global health problem due to its potential to cause complications such as stroke and heart failure. Early detection and accurate classification of arrhythmia are crucial for appropriate medical intervention. Although deep learning holds promise for automatic arrhythmia detection using ECG signa...

Long exposure of cardiovascular risk factor were correlated with vascular aging due to interaction of oxidative stress or inflammation exposure leading alteration of vascular adaptation. Garcinia Mangostana Periparpium extract has been reported to display antioxidant effect and immunomodulatory properties. The current research was undertaken to exp...

Background: Premature coronary artery disease (PCAD) is a significant health concern globally, characterized by the onset of coronary atherosclerosis at an early age. The development of PCAD is influenced by a variety of risk factors and leading to substantial morbidity and mortality. Despite advancements in interventions, the clinical and angiogra...

Objective Atrial fibrillation (AF) is one of the most common arrhythmic disorders worldwide. This study aims to describe the prevalence of AF in various cities in Indonesia using single‐lead hand held electrocardiography linked to a smartphone‐based application. Methods This is a cross‐sectional epidemiological study conducted at tertiary hospital...

Background: One to four percent of all cases of deep vein thrombosis (DVT) occur in the upper extremities. Effective thrombolysis for upper extremity deep vein thrombosis (UEDVT) can be achieved with a combination of vascular interventions such as angioplasty, which is continued with catheter-directed thrombolysis (CDT) and anticoagulant therapy. C...

Inappropriate therapy is a frequent adverse consequence of implantable cardioverter-defibrillator. Inappropriate therapy often occurs due to the misinterpretation of sinus tachycardia or atrial fibrillation/flutter with rapid atrioventricular conduction by the device. Current implantable cardioverter-defibrillator (ICD) mechanisms integrate various...

Ivabradine, a pure bradycardic agent, can be given to heart failure reduced ejection fraction (HFrEF) patients with a sinus rhythm of ≥70 bpm on a maximum beta blocker dose, or when beta blockers are contraindicated. This study aimed to see how ivabradine affects the clinical and haemodynamic outcomes of HFrEF patients. This systematic review and m...

Background: Recent studies showed no outcome difference between strict and lenient rate control in the general Atrial Fibrillation (AF) population. However, for AF and Rheumatic Mitral Stenosis (RMS) patients, evidences were lacking. Objective: To assess the impact of strict and lenient heart rate control on the Six-Minute Walk Test (SMWT) and Heal...

Background: Patients diagnosed with Wolff-Parkinson-White syndrome (WPW) have a relatively low, nevertheless persistent risk of unexpected mortality. However, this risk can be effectively mitigated by applying radiofrequency catheter ablation targeting the accessory pathway. It is difficult to accurately study predictors because only a minority of...

Background: Pulmonary Hypertension (PH) is a condition where there is an increase in Pulmonary Vascular Resistance (PVR) and an increase in the mean Pulmonary Arterial Pressure (mPAP) to more than 20 mmHg. PH can occur in someone with Congenital Heart Disease (CHD). PH conditions can aggravate pregnancy in women with CHD. Women with PH are recommen...

While young sudden cardiac death (SCD) is statistically uncommon, its dramatic presentation and impact on families and communities make it a newsworthy issue. Nonetheless, it is important to view SCD in children and adolescents as a public health concern and devise strategies based on research and consensus to address it. Both individuals with and...

Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure (mPAP) above normal (> 20 mmHg) and an increase in pulmonary vascular resistance (pulmonary vascular resistance / PVR) above normal in resting settings. The pathophysiology of PH involves remodeling of the pulmonary vessels, from the main pulmonary arteries, l...

Arrhythmia is a life-threatening cardiac condition characterized by irregular heart rhythm. Early and accurate detection is crucial for effective treatment. However, single-lead electrocardiogram (ECG) methods have limited sensitivity and specificity. This study propose an improved ensemble learning approach for arrhythmia detection using multi-lea...

Background: The Brugada syndrome is a type of cardiac arrhythmia frequently overlooked because of the dynamic character of the condition. Because it tends to progress into ventricular arrhythmias, it is a disorder that, if left untreated, carries the risk of being deadly. Not only is it essential for the practicing clinician to understand the situa...

Background: Tobacco smoke exposure induces intima-media thickness by reducing nitric oxide and increasing adhesive molecule activity, with circulating cotinine serving as a marker; we hypothesize a correlation between monocyte chemoattractant protein-1 (MCP-1) and carotid intima-media thickness (cIMT) in active male smokers. Material and Methods: W...

BACKGROUND: Sudden mortality due to persistent VT or VF accounted for around half of all fatalities in these high-risk individuals. Myocardial ischemia, acute heart failure, electrolyte abnormalities, hypoxia, and drug-related arrhythmogenicity are all risk factors for electrical storms. The most common electrolyte imbalance is hypokalemia. CASE IL...

Background: The majority of studies indicate that the asymptomatic or atypical presentation of acute coronary syndrome (ACS) as a significant manifestation of coronary artery disease (CAD) is associated with a poor prognosis. Objective: The purpose of this study was to characterize the clinical characteristics and management of ACS patients who pre...

Background: The most common reason for prehospital delay in acute coronary syndrome (ACS) patients is a lack of symptoms awareness. Patient-oriented machine learning algorithms may help the patient recognize ACS symptoms, reducing the prehospital delay that determines the clinical outcome of ACS patients. Objective: Assessing the accuracy of the se...

Background: Ventricular tachycardia (VT), a potentially fatal arrhythmia, is the primary cause of sudden cardiac fatalities. Ischemic heart disease is the underlying condition that most frequently causes ventricular tachycardia. Understanding the pathogenesis of VT and underlying structural heart disease is crucial for the proper management of VT a...

Even in the absence of antecedent myocardial infarction or congestive heart failure, atrial fibrillation (AF) is the most frequent arrhythmia seen in daily practice. There are several important predisposing factors for the initiation of AF, including growing older, being a man, being female, having high blood pressure, and having cardiac and noncar...

Background Even before it is clinically diagnosed, atrial fibrillation (AF) can cause a stroke. This study validates self‐pulse assessment and clinical scoring (MENARI Plus) based on android apps. Objective The aim of this study was to examine the validity of AF screening using MENARI Plus compared with an ECG recording. Methods We collected a to...

Background Genetic factors contribute to the AF pathophysiology by altering the structural and functional properties of proteins involved in different cellular activities. MicroRNAs (miRNAs), which take part in structural and electrical remodeling during the AF evolution, are important genetic elements that must be considered. The aim of study is t...

This research studies the effects of both Daubechies wavelet basis function (DWBF) and decomposition level (DL) on the performance of detecting atrial fibrillation (AF) based on electrocardiograms (ECGs). ECG signals (consisting of 23 AF data and 18 normal data from MIT-BIH) were decomposed at various levels using several types of DWBF to obtain fo...

Background: Ventricular Tachycardia (VT) storm or electrical storm (ES) is defined as cardiac electrical instability and refers to the occurrence of three or more ventricular tachyarrhythmias (VT and or ventricular fibrillation (VF)) in a 24-hour period, or VT recurring soon (within five minutes) after termination of another VT episode, or sustaine...

Introduction. Many research have looked into the potential of various biomarkers as predictors of intrahospital mortality in patients with STEMI. Patients with a history of heart failure, patients with STEMI with cardiogenic shock, and patients with heart failure all had a similar association between pro-BNP NT and intra-hospital mortality. In STEM...

Background: The likelihood of a poor clinical outcome is significantly increased in patients with acute decompensated heart failure. Mechanical ventilation was necessary for 23% of ADHF patients receiving treatment. The simple parameters of blood pressure and heart rate have good accuracy and repeatability. The development of the Acute Hemodynamic...

Introduction. Perioperative myocardial infarction (PMI) associated with the surgical revascularization (CABG) occurs in about 3–5% of patients. Myocardial necrosis and ischaemia after CABG are caused by direct cardiac trauma from manipulation, reperfusion injury, incomplete revascularization, hypotension, bleeding, ventricular arrhythmia, acute gra...

Patients undergoing coronary artery bypass grafting (CABG) have a risk of postoperative complications that result in prolonged hospitalization and even death. Interventions in the form of phase I cardiac rehabilitation are needed to help speed up the postoperative recovery process and prevent complications after CABG. Although a lot of research has...

Background: The incidence of sinus node dysfunction (SND) increases with age. Likewise, the incidence of coronary artery disease (CAD) has increased from year to year in Indonesia. When doctors are faced SND patients with CAD, it can be confusing in determining initial treatment options. Objective: This study aimed to describe the diagnosis and man...

Background: The advantage of prophylactic cavotricuspid isthmus (CTI) ablation for AF patients without documented atrial flutter is still unclear. The present study aimed to evaluate the role of prophylactic CTI ablation in this population. Methods: A systematic review and meta-analysis study was conducted. The overall effects estimation was conduc...

A 28-year-old male wasaadmittedto hospitalwwith chief complaint chestadiscomfort. There were symptoms of dyspnea on effort and palpitation before. He had a history of alcoholics for more than five years. The ECG showed frequent Premature Ventricular Complex (PVC) and recommended to have ambulatory Holter monitoring with conclusion frequent monomorp...

Background: Chronic total coronary occlusion (CTOs) is associated with an increased risk of adverse clinical outcomes. The benefits of percutaneous coronary intervention (PCI) in CTO are still being debated due to the limited data available. This study aims to determine the relationship between the success of PCI in CTOs and the reduction of major...

BACKGROUND: Obesity has been widely reported to be associated with loss of kidney function. The efficacy of β-1,3/1,6-D-glucan as a traditional medicine for the improvement of inflammation and vascular status in obesity has known. However, there have been no further studies that prove the effect of β-1,3/1,6-D-glucan in inhibiting kidney injury as...

Background : Limited resources and the concurrent COVID19 pandemic hinders the appropriate time to achieve reperfusion in Infarct-related artery (IRA). The number of patients receiving late primary PCI (PPCI) and without revascularization are steadily increase within 2 years into the pandemic. The impact of PCI timing in this setting has not been f...

The superiority of second-generation cryoballoon (2G-CB) ablation versus contact force-sensing radiofrequency (CF-RF) ablation in patients with paroxysmal atrial fibrillation (AF) was assessed in this systematic review and meta-analysis. Freedom from atrial tachyarrhythmias (ATAs) (OR = 0.89; 95% confidence interval [CI] = 0.68 to 1.17; p = 0.41),...

Background : Percutaneous coronary intervention (PCI) is one of the revascularization options in patients with clinical acute coronary syndrome (ACS) who often have multiple and complex vascular lesions. So, the decision to complete revascularization is still a topic that is widely explored to reduce the rate of rehospitalization and reinfarction....

Reperfusion is a critical component of myocardium survival in acute myocardial infarction to minimize infarct size and improve clinical prognosis. Reperfusion, on the other hand, may result in increased and accelerated myocardial injury, a condition known as reperfusion injury. Following reperfusion, several arrhythmias are observed, and it is call...

Background: Various treatment strategies to treat AF and reduce its complications have been developed, including anticoagulant administration. Non-Vitamin K antagonist oral anticoagulants (NOAC) are recommended by current guidelines. Different anticoagulants revealed different safety and efficacy characteristic. The real-world evidence-based recomm...

Background Atrioventricular reentrant tachycardia (AVRT) could be the reentrant tachyarrhythmia that occurs in Wolff-Parkinson-White (WPW) syndrome. In AVRT, the existence of normal AV node and accessory pathway (AP) along with the atria and ventricles establish the electrical circuit that permits impulse re-entry. The incidence of multiple accesso...

Background AF patient with refractory to optimal medical therapy for rate or rhythm control, atrioventricular (AV) nodal ablation with permanent pacemaker (PPM) implantation is an effective strategy for symptomatic relief. Maintenance of controlled ventricular rate helps to avoid frequent exacerbations of CHF and tachycardia-mediated cardiomyopathy...

Background AF patient with refractory to optimal medical therapy for rate or rhythm control, atrioventricular (AV) nodal ablation with permanent pacemaker (PPM) implantation is an effective strategy for symptomatic relief. Maintenance of controlled ventricular rate helps to avoid frequent exacerbations of CHF and tachycardia-mediated cardiomyopathy...

Background Atrioventricular reentrant tachycardia (AVRT) could be the reentrant tachyarrhythmia that occurs in Wolff-Parkinson-White (WPW) syndrome. In AVRT, the existence of normal AV node and accessory pathway (AP) along with the atria and ventricles establish the electrical circuit that permits impulse re-entry. The incidence of multiple accesso...

Background and Aims Fibrinolytic therapy (FT) is the alternative recommendation in patients with ST-segment elevation myocardial infarction (STEMI) if primary percutaneous coronary intervention (PCI) could not be perfomed timely at initial presentation. Successful revascularization of occluded infarct-related coronary arteries depends on complex me...

The temporary pacemaker (TPM) insertion must be done in symptomatic bradycardia to provide adequate heart rate and stable hemodynamic. Transvenous TPM is inserted under fluoroscopy guidance. However, in an extraordinary situation, such as the unavailability of the catheterization laboratory, transvenous TPM insertion can be performed using the blin...

Background: To overcome the several drawbacks of warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were developed. Even though randomized controlled trials (RCTs) provided high-quality evidence, the real-world evidence is still needed. This systematic review and meta-analysis proposed to measure the safety and efficacy profile between...

Introduction: Ebstein’s anomaly is a rare abnormality of the heart associated with atrialization right ventricle and apical (downward) displacement of the tricuspid valve functional annulus. Twenty percents of patients with Ebstein’s anomaly accompanied with accessory pathway. The dilatation of atrium and aging process may develop atrial fibrillati...

Background Radiofrequency catheter ablation (RFCA) using the high-power short duration (HPSD) results in better ablation lesion formation in the swine model. This systematic review and meta-analysis purposed to investigate the safety and efficacy profile between HPSD and low-power long-duration (LPLD) ablation strategies to treat atrial fibrillatio...

Background : Fibrinolytic therapy (FT) is the alternative recommendation in patients with ST-segment elevation myocardial infarction (STEMI) if primary percutaneous coronary intervention (PCI) could not be perfomed timely at initial presentation. Successful revascularization of occluded infarct-related coronary arteries depends on complex mechanism...

Background Pulmonary vein isolation (PVI) is the main ablation approach for paroxysmal atrial fibrillation (AF). The superiority of the second-generation cryoballoon (2G-CB) ablation over contact force-sensing radiofrequency (CF-RF) ablation is unclear. Therefore, we sought to investigate the superiority of 2G-CB ablation over CF-RF ablation in par...

Background: Data on the optimal therapeutic international normalized ratio (INR) for non-valvular and valvular atrial fibrillation (AF) in Indonesia is currently unavailable. Therefore, we designed the Indonesian Registry on Atrial Fibrillation (OneAF) registry in order to seek a safe and beneficial range of INR in Indonesian patients with non-val...

Background : ACE inhibitors through reverse remodeling mechanisms may encounter secondary LV changes due to rheumatic MR. Studies regarding RHD in Indonesia, however, remain limited. Objectives : This study purposed to define the characteristic profile of pediatric rheumatic heart disease patients with mitral regurgitation who received ACE inhibito...

Background: Arteriovenous fistula (AVF) has better rate of patency and lower rate of complication compared to other vascular access for hemodialysis. One priority to be concerned is access failure for hemodialysis access is common findings and correspond with high healthcare cost, morbidity and mortality. Objective: This case report aimed to elabor...

Background : Atherosclerosis is the pivotal role in cardiovascular disease (CVD) involving oxidative stress dan inflammation. Garcia Mangostana has been proven to have an antioxidant property for years; however, the application of this compound in the case of atherosclerosis has not been performed. Objectives : This study was performed to explore t...

Background Atrial fibrillation (AF) is correlated with a high risk of mortality, poor biventricular pacing, and inadequate response to cardiac resynchronization therapy (CRT). Biventricular pacing improvement could be achieved by conducting atrioventricular junction ablation (AVJA). We aimed to investigate the benefit of AVJA for patients with perm...

Background: Background Syncope is a frequent problem among patients who present to the ED, accounts for 3% of emergency department admission and 1% of hospitalization. It is characterized by a comparatively short and self-limited loss of consciousness, which is caused by temporary cerebral hypoperfusion. Objective: Therefore, Risk stratification pe...

Background : Patients with acute heart failure and left bundle branch block (LBBB) presenting acute chest pain have many clinical challenges to perform the diagnostic and therapeutic process. Recent recommendations revealed that the patients with LBBB (new or presumably new) should be performed early revascularization. However, several clinical con...

Background : Pulmonary hypertension (PH) is a global disease that affects all age groups and progresses in later years. Pregnancy with PH has a poor prognosis, and it is because of delayed diagnosis or even undiagnosed. PH gives high-risk to the mother and fetus; therefore, arranging a multidisciplinary team for pregnancy and delivery management is...

BACKGROUND: Atrial fibrillation (AF) could be triggered by inflammation and oxidative stress. Ganoderma lucidum has an active substance in the form of β-glucan that can reduce inflammatory process and oxidative stress in rats. The objective of this study was to evaluate the effect of Ganoderma lucidum polysaccharide peptide (GLPP) in paroxysmal AF...

Background Non-paroxysmal atrial fibrillation (AF) has a complex pathophysiological process. The standard catheter ablation approach is pulmonary vein isolation (PVI). The additional value of complex fractionated electrogram (CFAE) ablation is still unclear. We aimed to investigate the additional value of CFAE ablation for non-paroxysmal AF. Metho...

Background : Recently, studies have concerned on the use of xanthones for treating patients with cardiovascular diseases. In our country, xanthones were found in Garcinia Mangostana Linn. Objectives : To assess the effect of Garcinia Mangostana Linn Extract (GMLE) to the levels of Circulating Endothelial Cells (CEC) and Endothelial Progenitor Cells...

The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) remains challenging. Detailed echocardiography is a sensitive tool for identifying structural and functional when ARVC is suspected. A thorough assessment of cardiac magnetic resonance imaging is required to further establish the diagnosis. This case illustration aimed to broad...

More than two decades after the introduction of cardiac resynchronization therapy (CRT) into clinical practice, respond to highly effective treatments for refractory drug heart failure (HF) approximately one-third of candidates persist to fail. This article will discuss indications for initiating a CRT, the definition of a response to a CRT, steps...

Cardiac Implantable Electronic Device (CIEDs) had been recommended as an integral part of heart failure management. Despite clear benefits on CIEDs itself, the rate of therapy penetration in Indonesia is still very low. Many contributing factors had been identified, they are lack of physician awareness, lack of referral, and mismatch between nation...

Background : Chronotropic incompetence (CI) is defined as the failure of the heart to increase its heart rate along with activity and is an independent predictor of cardiovascular morbidity and mortality. The gold standard for CI is based on a treadmill test. However, up to now, there is no guideline to recommend whether CI could be concluded accor...

Subclavian vein access is still one of the most favoured access options for cardiac implantable electronic device (CIED) implantation. For the physician, the technique is reasonably familiar and easy to carry out. However, this has several potential complications. In this case, we present a late complication of subclavian access. The patient presen...

In the beginning of the menopause transition, most women experience an increase in body weight and fat along with a decrease in lean body mass. Obesity during menopause is related to many diseases, including cardiovascular accident. Nicotine can activate α7nAChR which improves energy homeostasis. Nicotine also suppresses appetite and decreases body...

Menopause is a condition where a woman lost protection from estrogen, causing susceptibility to arterial stenosis (atherosclerosis) induced by increased free radicals’ activity and inflammation. It was reported that nicotine can reduce free radicals’ activity and act as an anti-inflammatory agent. This study means to explore the possibility of nico...

Cardiovascular disease contributes to 48% of deaths in the world. A cohort study at the Harapan Kita National Heart Center and 5 Indonesia hospitals in 2006 showed that the death rate due to heart disease in hospitals was around 6-12%. Rehospitalization rate reached 29% and the all-out expense of INA-CBG claimed for inpatient was Rp 42.4 trillion....

We presented a case of Wolff-Parkinson-White (WPW) Syndrome. A 69-year-old man was admitted for evaluation of frequent episodes of palpitation. The diagnosis of WPW syndrome was established based on the 12-lead surface electrocardiogram (ECG) and electrophysiology (EP) study. We conducted the radiofrequency ablation (RFA) to the accessory pathway (...

Background Simple bedside cardiovascular autonomic reflex test (CARTs) are usually used to determine cardiovascular autonomic neuropathy (CAN). CAN may contribute to chronotropic incompetence (CI) which is the inability of the heart rate (HR) to rise in proportion to an increase in metabolic demand. Determination of CI is widely based on measuremen...

Background : Brugada syndrome is an inherited disease characterized by an increased risk of sudden cardiac death owing to ventricular arrhythmias in the absence of structural heart disease. It has been reported that this syndrome is more prevalent in South-East Asia than in Western countries. Furthermore, genetic studies showed important contribut...

Background: Extract of Ganoderma lucidum Mycelium containing β-1,3/1,6-D-Glucan has shown to possess beneficial effects on cardiovascular diseases. Objective: To examine the effectiveness of β-1,3/1,6-D-Glucan (GLME) consumption to reduced blood pressure (BP) & inflammation in patients with hypertension. Material and Methods: A randomized, double-b...

Background: Heart disease is the number one cause of death globally. This disease is initiation affected by autonomic dysfunction which will cause disruption of the sympathetic-parasympathetic system. Heart Rate Recovery (HRR) is used to determineautonomic dysfunction.Objective: To determine the relationship of risk factors and cardiovascular treat...

Torsade De Pointes is typical form of polymorphic ventricular tachycardia. It was in the setting of bradycardia when first described. We present a case of patient coming to emergency room with torsade de pointes development who was found to have bradycardia on basal electrocardiography record. In fact, bradycardia has been shown as a cause of acqui...