Effectiveness of Diosmin, Cumarin and Arbutin in Reducing Edema and Pain After Hip or Knee Arthroplasty.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a severe genetic heart muscle disorder characterized by life-threatening ventricular tachycardia (VT) and a high risk of sudden cardiac death (SCD). This condition primarily affects young and active individuals; population studies have shown that ARVC accounts for 20% of SCD in athletes younger than 35 years old and 30% of sudden death in young adults. Approximately 60% of ARVC cases are due to mutations in desmosomal genes, with plakophilin-2 () being the most prevalent; about 30% are considered gene-elusive (GE), with the causative genetic variants remaining unidentified. The arrhythmogenic mechanisms of and GE-associated ARVC cases are different, but both present with arrhythmogenic fibrotic replacement in the right ventricular (RV) myocardium. Additionally, electrophysiological (EP) remodeling from -related ion channel dysfunction can further disrupt electrical propagation and lead to the formation of complex reentrant arrhythmia circuits. The distinct arrhythmogenic substrates of and GE suggest potential differences in ARVC clinical presentation and a need for genotype-specific clinical management. Catheter-based radiofrequency ablation is a key treatment for controlling VT in patients with ARVC. The procedure aims to identify critical sites of the VT reentrant circuit and render them non-conductive, thus interrupting the circuit. However, the effectiveness of catheter ablation varies considerably among patients and is accompanied by a high VT recurrence rate. Patients often require multiple repeated procedures, sometimes within short periods of time. This primarily results from challenges in identifying all possible VTs and selecting the effective ablation targets during the procedure. Technical limitations, such as inadequate mapping resolution and the three-dimensional (3D) nature of the reentrant circuit, hamper the precise localization of VT-sustaining sites. Additionally, patients often exhibit hemodynamic intolerance which prevents the VTs from being mapped, making it difficult to localize critical sites. These limitations can result in VT incomplete elimination, requiring additional ablations that inflict unnecessarily large lesions and compromise cardiac function, and prolonged procedures that increase complication risks. There is, therefore, an urgent need to address these clinical challenges to enhance the therapeutic efficacy of ARVC ablation. Digital twining is an emerging technology in precision medicine that uses a set of virtual information constructs to mimic the behavior of an organ or even a patient and has predictive capability that informs clinical decisions. Heart digital twins (DTs), which integrate the patient’s cardiac imaging, clinical information, and basic biophysical knowledge, have already made significant contributions to patient disease prognostication and therapy delivery guidance. The technology has demonstrated accurate prediction of personalized risk of sudden cardiac death by evaluating the arrhythmogenic propensity of the patient’s disease-induced substrate. It has shown promise in non-invasively guiding the catheter ablation procedure in patients with persistent atrial fibrillation while minimizing ablation lesions. Beyond these clinical applications, the DT approach has also been used to dissect the arrhythmogenic mechanisms of various substrates, including fibrosis and penetrating adiposity.