Arrhythmias and sudden cardiac death in post-cardiac transplant patients
Purpose of review Orthotopic heart transplantation (OHT) significantly improves morbidity and mortality in patients with end-stage heart disease. Despite advances in surgical technique, immunosuppressive therapies, and patient monitoring, long-term risk of arrhythmias and sudden cardiac death (SCD) in the denervated heart remains unchanged. Recent findings SCD is responsible for approximately 10% of all posttransplant deaths with a pooled incidence rate of 1.30 per 100 person years and is strongly associated with cardiac allograft vasculopathy (CAV). Risk factors for SCD and CAV include higher donor age, younger recip...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Keeping pace with the competition: His bundle versus biventricular pacing in heart failure
Purpose of review His bundle pacing (HBP) has emerged as a novel method to achieve electrical resynchronization in bundle branch block and as an alternative means to deliver cardiac resynchronization therapy (CRT). There are now data on HBP in CRT-eligible patients from cohort studies and a single pilot randomized controlled trial (RCT). Recent findings Early clinical data regarding HBP in heart failure have demonstrated echocardiographic and functional improvement similar to traditional biventricular pacing (BiV), mostly when utilized as a bailout to traditional BiV-CRT. A single pilot RCT, His-SYNC, showed a trend t...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Management of ventricular arrhythmias in patients with LVAD
Purpose of review Left ventricular assist devices (LVADs) have extended the life expectancy of patients with heart failure. The hemodynamic support afforded by LVADs in this population has also resulted in patients having prolonged ventricular arrhythmias. The purpose of this article is to review the mechanisms of ventricular arrhythmias in LVADs and the available management strategies. Recent findings Recent evidence suggests that prolonged ventricular arrhythmias may result in increased mortality in patients with LVADs. Summary Successful management of ventricular arrhythmias in patients with LVAD requires interd...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Ventricular arrhythmias in heart failure with reduced ejection fraction
Purpose of review To provide a framework for approaching ventricular arrhythmias in the setting of cardiomyopathy, outline the latest evidence-based recommendations for catheter ablation and device therapy, and discuss novel treatment strategies. Recent findings Risk stratification of ventricular arrhythmias in systolic heart failure has evolved, with an increasing role for cardiac magnetic resonance imaging to identify underlying substrate and scar burden. Medical therapy for heart failure has greatly improved, and the role of primary prevention defibrillators in nonischemic cardiomyopathy has become more ambiguous. ...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Atrial arrhythmias in patients with left ventricular assist devices
Purpose of review Atrial arrhythmias commonly occur in patients with advanced heart failure with reduced ejection fraction (HFrEF) who require left ventricular assist devices (LVADs) implantation. This review summarizes the current literature regarding the incidence, prevalence, and predictors of atrial arrhythmias in LVAD patients and its impact on the clinical outcomes. Moreover, we review the mechanisms and management strategies of atrial arrhythmias in this population. Recent findings Atrial arrhythmias including atrial fibrillation, atrial flutter, and atrial tachycardia are highly prevalent in patients with adva...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Atrial arrhythmias in heart failure with a reduced ejection fraction
Purpose of review Atrial arrhythmias are common among individuals with heart failure with a reduced ejection fraction (HFrEF). This review describes management options for these arrhythmias and discusses emerging clinical data supporting catheter ablation. Recent findings Several recent clinical trials indicate that catheter ablation is superior to pharmacologic therapy for management of symptomatic atrial fibrillation in the setting of HFrEF. Restoration and maintenance of sinus rhythm appears to have the greatest benefit with regard to ejection fraction improvement among individuals with a nonischemic heart failure ...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Atrial fibrillation in patients with heart failure with preserved ejection fraction
Purpose of review To review the shared pathology of atrial fibrillation and heart failure with preserved ejection fraction (HFpEF) and the prognostic, diagnostic, and treatment challenges incurred by the co-occurrence of these increasingly prevalent diseases. Recent findings Multiple risk factors and mechanisms have been proposed as potentially linking atrial fibrillation and HFpEF, with systemic inflammation more recently being invoked. Nonvitamin K oral anticoagulants, left atrial appendage occlusion devices, and catheter ablation have emerged as alternative treatment options. Other novel pharmacological agents, suc...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Editorial: Electrophysiology in heart failure: notes from the cutting edge
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Molecular genetics of human hypertension
Purpose of review Genetic variance on blood pressure was shown about 100 years ago; a Mendelian inheritance was initially presumed. Platt and Pickering conducted a lively debate, whether blood pressure was inherited in a Mendelian fashion or whether the condition was polygenic. Genetic-hypertension research has appropriately followed both pathways. Recent findings Genome-wide association studies, Pickering model, have identified more than 500 blood-pressure loci, the targets of which are waiting to be evaluated. Then, come the ‘dark-horses’ of hypertension, namely ‘secondary’ causes. These cond...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Recent advances in genome editing for cardiovascular disease
Purpose of review This review highlights recent progress in applying genome editing to the study and treatment of cardiovascular disease (CVD). Recent findings Recent work has shown that genome editing can be used to determine the pathogenicity of variants of unknown significance in patient-derived induced pluripotent stem cells. These cells can also be used to test therapeutic genome editing approaches in a personalized manner. Somatic genome editing holds great promise for the treatment of CVD, and important proof of concept experiments have already been performed in animal models. Here we briefly review recent prog...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Role of epigenetic mechanisms regulated by enhancers and long noncoding RNAs in cardiovascular disease
Purpose of review Hyperlipidemia, hypertension, diabetes and related metabolic disorders increase the risk for cardiovascular disease (CVD). Despite significant progress in the identification of key mechanisms and genetic polymorphisms linked to various CVDs, the rates of CVDs continue to escalate, underscoring the need to evaluate additional mechanisms for more effective therapies. Environment and lifestyle changes can alter epigenetic mechanisms mediated by histone modifications and long noncoding RNAs (lncRNAs) which play important roles in gene regulation. The review summarizes recent findings on the role of epigenet...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

The brave new world of genetic testing in the management of the dyslipidaemias
Purpose of review With the exception of familial hypercholesterolaemia, the value of genetic testing for managing dyslipidaemias is not established. We review the genetics of major dyslipidaemias in context of clinical practice. Recent findings Genetic testing for familial hypercholesterolaemia is valuable to enhance diagnostic precision, cascade testing, risk prediction and the use of new medications. Hypertriglyceridaemia may be caused by rare recessive monogenic, or by polygenic, gene variants; genetic testing may be useful in the former, for which antisense therapy targeting apoC-III has been approved. Familial hi...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Genetics of age-related clonal hematopoiesis and atherosclerotic cardiovascular disease
Purpose of review While advanced age is the major risk factor for the development of atherosclerotic cardiovascular disease (ASCVD), we have a poor understanding of how aging promotes the progression of this disease. Recent evidence suggests that the age-dependent accumulation of somatic mutations in hematopoietic cells may represent a new causal risk factor for ASCVD. Recent findings A hallmark of aging is the accumulation of somatic DNA mutations in all tissues of the body. Accordingly, evidence shows that hematopoietic stem/progenitor cells accumulate somatic mutations as a function of age in nonsymptomatic individ...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Gut microbiome and cardiovascular disease
Purpose of review This review aims to highlight the association between gut microbiome and cardiovascular disease (CVD) with emphasis on the possible molecular mechanisms by which how gut microbiome contributes to CVD. Recent findings Increasingly, the roles of gut microbiome in cardiovascular health and disease have gained much attention. Most of the investigations focus on how the gut dysbiosis contributes to CVD risk factors and which gut microbial-derived metabolites mediate such effects. Summary In this review, we discuss the molecular mechanisms of gut microbiome contributing to CVD, which include gut microbe...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Functional characterization of long noncoding RNAs
Purpose of review Mounting evidence suggests that long noncoding RNAs (lncRNAs) are essential regulators of gene expression. Although few lncRNAs have been the subject of detailed molecular and functional characterization, it is believed that lncRNAs play an important role in tissue homeostasis and development. In fact, gene expression profiling studies reveal lncRNAs are developmentally regulated in a tissue-type and cell-type specific manner. Such findings have brought significant attention to their potential contribution to disease cause. The current review summarizes recent studies of lncRNAs in the heart. Recent fi...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

RNA-based therapeutics in cardiovascular disease
Purpose of review Cardiovascular disease is the leading cause of death globally, with the number of deaths rising every year. Much effort has gone into development of new treatment strategies. Many RNA species have important regulatory functions in disease initiation and progression, providing interesting new treatment options. This review focuses on different classes of RNA-based therapeutics and provides examples of current clinical and preclinical studies. Current challenges that prevent clinical translation and possibilities to overcome them will be discussed. Recent findings Different RNA-based molecules have bee...
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Editorial: Overcoming current limitations of genetic testing in cardiovascular medicine
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: MOLECULAR GENETICS: Edited by Ali J. Marian Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - April 7, 2020 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Sodium-glucose cotransporter 2 inhibitors and type 2 diabetes: clinical pearls for in-hospital initiation, in-hospital management, and postdischarge
Purpose of review The aim of this article is to provide practical recommendations on safe initiation of sodium-glucose cotransporter 2 (SGLT2) inhibitors to in-patients as well as management of those who are already on SGLT2 inhibitors. Recent findings Robust data from stable outpatient cohorts indicate that the SGLT2 inhibitors are associated with clinically meaningful reductions in major adverse cardiovascular events, lower rates of hospitalization for heart failure, and a reduction in major kidney outcomes There is however a lack of information on how to initiate and manage SGLT2 inhibitors in an acute in-patient s...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: SPECIAL COMMENTARY Source Type: research

Global longitudinal strain is a better metric than left ventricular ejection fraction: lessons learned from cancer therapeutic-related cardiac dysfunction
Purpose of the review This review aims to highlight the utility of global longitudinal strain (GLS) in cancer therapeutic-related cardiac dysfunction (CTRCD), with an attempt to stipulate that GLS might be a better measure than left ventricular ejection fraction (LVEF). Recent findings Increasingly, GLS quantification has been employed in various cardiovascular diseases especially with its ability to detect left ventricular dysfunction subclinically, even before a change in LVEF is visualized. In fact, several studies reveal that GLS may be a superior predictor of mortality and morbidity than LVEF in this context. A r...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Choosing the best antithrombotic regimen in patients with ventricular assist devices
Purpose of review Two major complications compromise the outcomes and quality of life for left ventricular assist device (LVAD) patients. This review aims to discuss the mechanisms of thrombosis and bleeding, recent literature on the optimal approaches for antithrombotic therapy, and novel approaches to prevent bleeding. Recent findings Recent studies with the newly designed LVAD, the fully magnetically levitated rotor, show lower thrombotic risk but sustain similar bleeding risk. Small studies present options for less intense antithrombotic regimens with the newer devices. Bridging anticoagulation when needed in this...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

End-of-life care in patients with advanced heart failure
Purpose of review With an aging population with heart failure, there is a growing need for end-of-life care in this population, including a focus on symptom management and quality-of-life considerations. Recent findings Targeted therapies focusing on symptom control and improving quality of life is the cornerstone of providing care in patients with heart failure near the end of life. Such therapies, including the use of inotropes for palliative purposes, have been shown to improve symptoms without an increase in mortality. In addition, recent evidence shows that implementing certain strategies in planning for end of l...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Hyperkalemia in heart failure
Purpose of review Hyperkalemia is increasingly prevalent in the heart failure population as more people live with heart failure and comorbid conditions such as diabetes and chronic kidney disease. Furthermore, renin–angiotensin–aldosterone (RAAS) inhibitors are a key component of clinical therapy in these populations. Until now, we have not had any reliable or tolerable therapies for treatment of hyperkalemia resulting in inability to implement or achieve target doses of RAAS inhibition. This review will focus on two new therapies for hyperkalemia: patiromer and sodium zirconium cyclosilicate (SZC). Recent f...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Mechanical circulatory support in cardiogenic shock
Purpose of review Cardiogenic shock remains a complex clinical syndrome with high morbidity and mortality. The purpose of this article is to review important landmark trials as well as the relevant recent literature for percutaneous mechanical circulatory support following acute myocardial infarction. Recent findings The sole use of intraaortic balloon pumps for cardiogenic shock following acute myocardial infarction continues to be questioned with downgrading of its recommendation in recent years, there however may remain a role in patients with mechanical complications of their myocardial infarction. The combined us...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

The risk and prevention of sudden death in patients with heart failure with reduced ejection fraction
Purpose of review Patients with heart failure are at increased risk of sudden cardiac death. The methods to predict patients at high risk of sudden cardiac death in heart failure are neither sensitive nor specific; both overestimating risk in those with ejection fractions less than 35% and not identifying those at risk with ejection fractions greater than 35%. Recent findings The absolute risk of sudden cardiac death in patients with heart failure have decreased over the past 20 years. New novel tools are being developed and tested to identify those at higher risk of sudden cardiac death. Reduction in the risk of sudd...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Iron deficiency in heart failure: getting to the guidelines
Purpose of review Iron deficiency is a common condition affecting approximately 50% of patients with heart failure. The purpose of this review is to explore the impact of iron deficiency on patients’ quality of life and outcomes. Moreover, how intravenous replacement, even in the absence of anemia, can improve these outcomes. Recent findings The role of iron deficiency anemia has long been a part of assessing reversible and treatable contributors to patients’ symptoms in heart failure. Recent studies have demonstrated how vital identifying not only anemic patients but those who are iron deficient without a...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: HEART FAILURE: Edited by Haissam Haddad Source Type: research

Modes of bioprosthetic valve failure: a narrative review
Purpose of review A thorough understanding of the modes of bioprosthetic valve failure is critical as clinicians will be facing an increasing number of patients presenting with failed bioprostheses in coming years. The purpose of this article is to review modes of bioprosthestic valve degeneration, their management, and identify gaps for future research. Recent findings Guidelines recommend monitoring hemodynamic performance of prosthetic valves using serial echocardiograms to determine valve function and presence of valve degeneration. Modes of bioprosthetic valve failure may be categorized as structural degeneration...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Speckle tracking echocardiography: imaging insights into the aorta
Purpose of review Pathophysiologic changes of aortic tissue may not always manifest as aneurysms, nor does the size of an aneurysm necessarily represent the severity of tissue abnormality – approximately 40% of patients who present with dissection have aortic diameters below criteria recommended for surgical resection. Noninvasive imaging-based quantification of aortic biomechanics has the potential to improve our knowledge of the pathophysiology of aortic disease, including patient-specific risk-stratification and intraoperative surgical decision-making. Recent findings We summarize the current state of clinica...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Surgical management of mitral annular calcification
Purpose of review The aim of the article is to discuss different therapeutic options for patients with severe mitral valve dysfunction because of mitral annular calcification (MAC), including mitral valve repair, conventional mitral valve replacement, percutaneous transcatheter mitral valve replacement (TMVR), and hybrid procedures. Recent findings Optimal management of severe mitral valve disease because of MAC remains challenging. Various ‘resect’ or ‘respect’ repair strategies have been standardized and are applicable in eligible patients. Mitral valve replacement with a standard surgical bi...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Is there a problem with respect? Risk of neochordal rupture
Purpose of review In this review, we summarize the history of mitral valve repair, discuss the broad principles of neochord preparation and implantation, and highlight comparative outcomes between mitral valve repair strategies while focusing on the risk of neochordal rupture. Recent findings There have been several recent studies comparing outcomes been leaflet-resection and nonresection, neochord-based mitral valve repair. Operative mortality was very low regardless of repair strategy; however, the rate of mitral valve reoperation is lower in those that undergo a neochord-based repair with overall lower mean mitral ...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Valve sparing root replacement: an update
Purpose of review Until the year 2000, the publications concerning aortic valve sparing (AVS) did not exceed 20 articles; in the following years almost 300 publications have appeared. Over 35 years from the introduction of valve sparing techniques and 500 years after the death of Leonardo da Vinci, this review highlights the significant steps in modern imaging techniques and the excellent clinical results in the field of reconstructive aortic root surgery. Recent findings AVS operations underwent significant modifications over the last few years making it reproducible with satisfactory outcomes. The extraordinary pote...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Diagnosis and management of low-flow, low-gradient aortic stenosis
This article summarizes current guidelines and best practices for the management of low-flow, low-gradient aortic stenosis. Summary Low-flow, low-gradient aortic stenosis is a difficult entity to diagnose and treat. Various diagnostic modalities are needed to accurately determine the severity of aortic stenosis and potential treatment benefit. True-severe classical and paradoxical low-flow, low-gradient aortic stenosis can be distinguished from pseudo-severe aortic stenosis by dobutamine stress echocardiography and/or multidetector computed tomography. Once the distinction is made, aortic valve replacement results in be...
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - February 6, 2020 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Screening for prevention of sudden death in the young: what is new?
Purpose of review The optimal approach to screening young people to decrease the risk of sudden death remains unknown. It deserves the passionate attention that researchers, clinicians and families have given it. The new data from January 2018 to July 2019 are reviewed here. Recent findings Cardiac findings associated with a risk of sudden death were reported in 0.4% of screened athletes. Well run programs continue report varying sensitivity for screening ECGs (between 86 and 100%). One major article reported a higher incidence of sudden death in young people than has been previously published (6.8/100 000 athletes)...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research

Cardiac surgical missions: what works, what does not, where we need to go from here
Purpose of review Although overall neonatal and infant mortality continues to decrease around the world, years of life lost to congenital heart disease (CHD) rank among the top 10 leading causes for that age group in Latin America, Central Asia, Africa and the Middle East. Short-term surgical missions (STSMs) continue to be the only resource available in some areas of the world. Recent findings There is a need for better communications between charity organizations and the supported institutions. We observe a raising concern with the limited published information on the results of the STSMs and a call for patient safe...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research

Not just to survive but to thrive: delirium in the pediatric cardiac ICU
Purpose of review Pediatric delirium has recently been recognized to occur frequently in the pediatric general and cardiac ICU. The purpose of this review is to highlight recent data on the prevalence, prevention, and management of this condition. Recent findings Pediatric delirium occurs in the pediatric cardiac ICU (PCICU) in as many as 67% of patients. Validated screening tools are now available to assist clinicians in the diagnosis of this condition. Research has shown a growing relationship between benzodiazepines, mainstays in the realm of sedation, and delirium. The full spectrum of risk factors has yet to be c...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research

Tetralogy of Fallot: risk stratification is straightforward. Or is it?
Purpose of review Tetralogy of Fallot (TOF) carries a long-term risk of arrhythmias and sudden death after surgical repair. Risk stratification is still less accurate than desired. Recent findings Several factors have been studied as risk predictors for ventricular arrhythmias and sudden death. Clinical parameters include age at surgery, time since repair, types of previous surgeries, and symptoms such as syncope and palpitations. Electrocardiographic parameters that have been studied include QRS interval, ventricular arrhythmias assessed with Holter monitors, signal averaged ECG, QRS fragmentation, QRS vector magnitu...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research

Beyond atrial septal defect closure, it is time to start seriously considering closing ventricular septal defects with devices
Purpose of review The purpose of this review is to discuss the history and current state of transcutaneous device closure of ventricular septal defects. Recent findings Newer devices and techniques have expanded the role of transcutaneous device closure of ventricular septal defects. Device closure of ventricular septal defects is a mainstay of therapy in many parts of the world. Device closure in smaller infants has relatively higher risks than larger infants and older children. The potential for the development of complete heart block remains a concern with this procedure. Summary Transcutaneous device closure of...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research

Dilated cardiomyopathy in children: moving beyond traditional pharmacologic therapy
This article will address the basic cause, epidemiology, pathobiology, and historical treatment approach of DCM and introduce novel contemporary medical and surgical strategies that may reduce the need for heart transplantation. Recent findings In the last 15 years, there has been a significant emphasis on identifying alternative treatment strategies in managing the child with a DCM and heart failure symptoms. New therapies have evolved to help bridge these critically ill children to transplant or have these therapeutic modalities serve as end-points in themselves. Thus subsequently, we will highlight contemporary as we...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research

Anomalous coronary arteries: what is known and what still remains to be learned?
Purpose of review To report what is known and unknown regarding coronary anomalies in children, particularly anomalous aortic origin of a coronary artery, efforts undertaken to answer several questions regarding evaluation and management of this challenging young population, and where the future is heading. Recent findings Patients with anomalous aortic origin of a coronary artery (AAOCA) present as an incidental finding at least half of the time, advanced imaging is essential to define anatomic characteristics of this lesion, assessment of myocardial perfusion with stress cardiac magnetic resonance imaging is feasibl...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research

Virtual reality in pediatric cardiology: hype or hope for the future?
Purpose of review In the field of pediatric cardiology, a sub-specialty that relies on an understanding of complex three-dimensional structures, virtual reality technology may represent a new and exciting tool for both practitioners and patients. Here, the current medical and surgical applications of virtual reality are reviewed and the potential for future applications explored. Recent findings Multiple centers have begun to develop software designed to bring virtual reality technology to bear on congenital heart disease. These efforts have focused on surgical preparation, on education of medical providers, and on pr...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research

Editorial: A contemporary look at pediatric cardiology in 2020
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: PEDIATRICS: Edited by Mitchell Cohen Source Type: research

Left atrial appendage occlusion: a critical appraisal updated with recent evidence
Purpose of review To allow readers to fully appreciate the uncertainties with this novel yet invasive approach to stroke prevention. Recent findings Percutaneous left atrial (LA) appendage occlusion has emerged as potential nonpharmacologic means to prevent stroke and systemic embolism in patients with atrial fibrillation. Yet the evidence underpinning this new technology is not definitive. Summary In this review, we consider the internal and external validity of the regulatory trials, pathophysiologic basis for LA appendage occlusion and clinical tradeoffs of the procedure. (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

His bundle pacing: conduction system capture and clinical impact
Purpose of review It has been nearly 2 decades since His bundle pacing (HBP) was described and with very first randomized pilot study published, reviewing its impact on clinical practice is inevitable. Recent findings Inclusion of HBP in the guidelines, along with long-term outcomes, outcomes comparing selective and non selective HBP and investigator initiated randomized pilot comparing with cardiac resynchronization therapy, HBP has established itself as a feasible pacing alternative. Summary HBP is an addition to the current armada of resynchronization techniques. HBP is an emerging area of interest, and is parti...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Radiofrequency versus cryoballoon ablation for atrial fibrillation: an argument for a ‘cryo-first’ approach
Purpose of review Radiofrequency and cryoballoon ablation are the two most common modalities for catheter ablation of atrial fibrillation. Radiofrequency, being more prevalent and having existed for a longer period, is often utilized for patients’ first ablations, despite the efficiency and efficacy of the cryoballoon tool. Here we examine the advantages of the cryoballoon for its use in first-time ablation of atrial fibrillation. Recent findings The FIRE & ICE trial is established as conclusive evidence of the noninferiority of cryoballoon ablation to radiofrequency ablation in terms of efficacy. Since the ...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Partnering with robotic technology in electrophysiology: have we arrived at a tipping point?
Purpose of review Bring readers up to date on the rationale for, current state of, and promising innovations in remote and robotic technology in electrophysiology. Recent findings There is a growing peer-reviewed literature regarding existing nontraditional technology for mapping and ablation. There also is accelerated innovation under early evaluation that promises significant impact. Summary The development and adoption of remote technologies in electrophysiology has faced considerable challenges yet holds tremendous promise for our patients. First principles must include benefit for patients in both safety and e...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Biomarkers in the risk assessment for stroke and dementia in atrial fibrillation
Purpose of review Atrial fibrillation is one of the most common clinically encountered arrhythmias exhibiting a strong association with a spectrum of cerebral injuries from the occurrence of clinical stroke, subclinical stroke, dementia, and cognitive decline. Dynamic noninvasive specific and sensitive diagnostic tests may allow a personalized approach to the atrial fibrillation patient's treatment based upon quantitative parameters, aiming to prevent or delay stroke, dementia, progressive cognitive decline, or to assess responses to these therapies. This review will explore molecular markers that have been shown to have...
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - January 1, 2020 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Cardiovascular risk reduction with icosapent ethyl
Purpose of review Residual risk for atherosclerotic cardiovascular disease (ASCVD) persists even among patients with optimal low-density lipoprotein cholesterol (LDL-C) levels. Randomized trials attempting to modulate other lipids beyond LDL-C have failed to demonstrate significant reductions in ischemic events. Recent findings Mounting evidence suggests that triglyceride elevation is an independent risk factor for ASCVD. Though trials of triglyceride-lowering therapy in the statin era have failed to provide protection from ASCVD events, subgroup analyses have revealed that those with the highest triglycerides at time...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research

Modulation of cholesterol efflux capacity in patients with myocardial infarction
This article reviews the current data on the ‘cholesterol efflux hypothesis’ and discuss its ability to be modulated has a potential therapeutic target. Recent findings Recent data have demonstrated that impaired serum CEC was associated with increased mortality after a myocardial infarction (MI). Thus, therapeutic intervention aiming to improve CEC and RCT may reduce the risk of recurrent events. Early phase clinical studies targeting CEC showed promising results and a megatrial is ongoing testing the hypothesis that an improved RCT trough a modulation of the CEC can modify patient's prognosis after an acut...
Source: Current Opinion in Cardiology - October 9, 2019 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research