Arrhythmias after Implantation of the Left Ventricular Assisted Device Arrhythmias after Implantation of the Left Ventricular Assisted Device

Cardiac arrhythmias has been frequently reported after left ventricular assist devices implantation but currently literature shows no sufficient information on cardiac arrhythmias. Objective: The aim of this study was to assess the frequency and other features of ventricular and supra ventricular ectopic beats ((SVEB), atrial fibrillation (AF)/flutter (AFL) post device implantation. Methods: This is a retrospective study conducted in Department of Cardiac-Surgery, University of Verona Medical School, Verona, Italy from June 2014-September 2016. Rhythm monitoring and registration were collected from 16 patients (13 males; 45±13years) during the first five (05) days after implantation. To assess late post-operative rhythm, patient’s hospital electronic records were used as well asfunctional hemodynamic parameters including mean arterial pressure(MAP), right atrial pressure(RAP), heart rate(HR) and ST-deviation(d-ST). Results: Ventricular arrhythmia (n=9), atrial fibrillation (n=5) or atrial flutter (n=2) episodes were preoperatively present in 11 patients. Postoperatively, 5 patients developed either VT (n=2), AF (n=1) or both VT/AF (n=2) during a follow-up of 18±14 months. Prior to postoperative VT (POVT) episodes (n=123), MAP decreased, HR, d-ST increased and RAP remained unaltered. POVT were initiated either by single VEBS (28%), V-couplets (15%), V-run (46%) or occurred suddenly (11%). Conclusions: Ventricular and supraventricular arrhythmias are common after device implantation. The frequency of sustained VTA was less at early phase as compared to late postoperative phase.

Threats to Pakistans Nuclear Weapons: Myth or Reality

Ever since Pakistan carried out its nuclear tests in 1998, the international community has voiced grave concerns over the prospects of Pakistan’s nuclear weapons or fissile material falling into the hands of non-state actors or terrorists. The threat of nuclear terrorism has gained exclusive attention after the events of September 11, 2001, with concerns that terrorists could create even greater destruction if they had gained possession and know-how of nuclear materials and technology. Today nuclear security has become a leading issue of concern in contemporary international politics. Various academics as well as policy analysts have expressed their apprehensions regarding the security of Pakistan’s nuclear programme. So many hypothetical scenarios are being projected in the Western media, portraying a dramatically chaotic situation about Pakistan’s nuclear assets. Since the international community is facing serious challenges regarding nuclear insecurity, any single nuclear incident by a non-state actor may disturb global peace. Elaborating on the serious security threats to Pakistan’s nuclear weapons, Western security analysts and policy makers have pointed out a potential threat from radical militants and their sympathizers in the civil and military organizations. Additionally, it is a fact that terrorist attacks on military installations, including suicide bombings, have been observed in the last few years, all heightening the perception that Pakistan’s nuclear weapons are not secure. Several suppositious situations have been developed by Western analysts in this context; such as, terrorists attacking Pakistan’s nuclear facilities, controlling its nuclear weapons, accidental or unauthorized use of nuclear weapons and questions on nuclear weapons’ security when military installations are under attack. The other side of picture presents a highly professional and confident Pakistan with state of the art safeguards and highly evolved personnel check mechanism involved in its nuclear security protocol. Pakistan’s nuclear establishment has always strongly rejected such claims by media and policy institutes. Pakistan’s nuclear weapons’ safety and security system is as much advanced and robust as the infrastructure of any other nuclear weapon state. International concerns regarding Pakistan’s nuclear weapon programme are based on hypothetical scenarios that have little chance of materialization. This study is an attempt to conduct an in-depth evaluation of the international concerns cultivated through media, Pakistan’s response and the safety measures taken by Pakistan. It is an overall assessment of the issues related to nuclear safety and security of Pakistan’s nuclear weapons programme. The study suggests that Pakistan needs to improve and strengthen its nuclear diplomacy through effective global representation with special focus on countering negative propaganda, which would be the best way to mitigate international concerns about the safety and security of Pakistan’s nuclear assets.