Corrigendum to: Kyriakopoulou M, et al. Evaluation of a simple technique aiming at optimizing point-by-point isolation of the left pulmonary veins: a randomized study
[Europace 2019;21:1185 –1192] (Source: Europace)
Source: Europace - August 3, 2019 Category: Cardiology Source Type: research

Let ’s get down to the nitty-gritty in persistent atrial fibrillation: the continuous critical mass of the atria—Authors’ reply
We would like to thank the author for making this excellent point regarding the possible mechanistic implications of our study.1 While we did find that linear ablation, posterior wall isolation (PWI), and complex fractionated atrial electrogram (CFAE) ablation was associated with increased intraprocedural atrial fibrillation (AF) termination, importantly only PWI and left atrial appendage (LAA) isolation was associated with improved freedom from AF. Intraprocedural AF termination was not associated with improved long-term freedom from AF.2 (Source: Europace)
Source: Europace - July 20, 2019 Category: Cardiology Source Type: research

Let ’s get down to the nitty-gritty in persistent atrial fibrillation: the continuous critical mass of the atria
I should like to express my hearty congratulations to the authors for this interesting article by Sauet al.1 They conclude that linear ablation, posterior wall isolation, complex fractionated atrial electrogram ablation improves intraprocedural atrial fibrillation (AF) termination. Moreover, left atrial (LA) size directly affects final outcome for AF ablation, by dropping down at a rate of 4% for every 1  mm increase in diameter for freedom from AF.1 Nevertheless, I should like to draw attention to the nitty-gritty. (Source: Europace)
Source: Europace - July 20, 2019 Category: Cardiology Source Type: research

Lead extraction for cardiac implantable electronic device infection: comparable complication rates with or without abandoned leads
ConclusionDespite longer implant times, patients with abandoned leads did not have more major complications during lead extraction. Therefore, preventive extraction of non-functional leads to avoid complications at a later stage is not warranted. (Source: Europace)
Source: Europace - July 19, 2019 Category: Cardiology Source Type: research

Upper loop re-entrant flutter
(Source: Europace)
Source: Europace - July 16, 2019 Category: Cardiology Source Type: research

Corrigendum to: 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
[Europace 2019;21:1143 –1144] (Source: Europace)
Source: Europace - July 13, 2019 Category: Cardiology Source Type: research

Vernakalant for cardioversion of recent-onset atrial fibrillation: a systematic review and meta-analysis
ConclusionVernakalant should be a first line option for the pharmacological cardioversion of patients with haemodynamically stable recent-onset AF without severe structural heart disease. (Source: Europace)
Source: Europace - July 10, 2019 Category: Cardiology Source Type: research

Electrically vs. imaging-guided left ventricular lead placement in cardiac resynchronization therapy: a randomized controlled trial
ConclusionElectrically guided CRT implantation appeared non-inferior to an imaging-guided strategy considering the outcomes of change in LVEF, LV reverse remodelling and clinical response. Larger long-term studies are warranted to investigate the effect of an electrically guided CRT strategy. (Source: Europace)
Source: Europace - July 4, 2019 Category: Cardiology Source Type: research

Apixaban enhances endogenous fibrinolysis in patients with atrial fibrillation
AbstractAimsApproximately 20% of ischaemic stroke patients exhibit spontaneous arterial recanalization, attributable to endogenous fibrinolysis, which strongly relates to improved functional outcome. The impact of oral anticoagulants on endogenous fibrinolysis is unknown. Our aim was to test the hypothesis that apixaban enhances endogenous fibrinolysis in non-valvular atrial fibrillation (NVAF).Methods and resultsIn a prospective cross-sectional analysis, we compared endogenous fibrinolysis in NVAF patients (n = 180) taking aspirin, warfarin, or apixaban. In a prospective longitudinal study, patients were tes...
Source: Europace - June 25, 2019 Category: Cardiology Source Type: research

Evaluation of a real-time magnetic resonance imaging-guided electrophysiology system for structural and electrophysiological ventricular tachycardia substrate assessment
ConclusionLow-voltage zones and regions of delayed conduction determined using a real-time MR-EP system are moderately associated with LGE areas identified on MRI. (Source: Europace)
Source: Europace - June 20, 2019 Category: Cardiology Source Type: research

Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association
ConclusionClinical practices for prevention and management of CIED do not fully comply with current recommendations and demonstrate considerable regional disparities. Further education and programmes for improved implementation of guidelines are mandatory. (Source: Europace)
Source: Europace - June 17, 2019 Category: Cardiology Source Type: research

Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation
AbstractAimsTo evaluate the effectiveness and safety of cryoballoon ablation (CBA) compared with radiofrequency ablation (RFA) for symptomatic paroxysmal or drug-refractory persistent atrial fibrillation (AF).Methods and resultsProspective cluster cohort study in experienced CBA and RFA centres. Primary endpoint was ‘atrial arrhythmia recurrence’, secondary endpoints were as follows: procedural results, safety, and clinical course. A total of 4189 patients were included: CBA 2329 (55.6%) and RFA 1860 (44.4%). Cryoballoon ablation population was younger, with fewer comorbidities. Procedure time was longer in the...
Source: Europace - June 14, 2019 Category: Cardiology Source Type: research

Micra pacemaker implant after cardiac implantable electronic device extraction: feasibility and long-term outcomes
ConclusionMicra implant is an effective and safe procedure in patients still requiring a ventricular pacing after TLE, with similar electrical performance and outcome compared with na ïve patients at long-term follow-up. (Source: Europace)
Source: Europace - June 10, 2019 Category: Cardiology Source Type: research

Prediction of ventricular arrhythmias in patients with a spontaneous Brugada type 1 pattern: the key is in the electrocardiogram
AbstractAimsThere is currently no reliable tool to quantify the risks of ventricular fibrillation or sudden cardiac arrest (VF/SCA) in patients with spontaneous Brugada type 1 pattern (BrT1). Previous studies showed that electrocardiographic (ECG) markers of depolarization or repolarization disorders might indicate elevated risk. We aimed to design a VF/SCA risk prediction model based on ECG analyses for adult patients with spontaneous BrT1.Methods and resultsThis retrospective multicentre international study analysed ECG data from 115 patients (mean age 45.1  ± 12.8 years, 105 males) with spont...
Source: Europace - June 9, 2019 Category: Cardiology Source Type: research

Effect of remote monitoring on patient-reported outcomes in European heart failure patients with an implantable cardioverter-defibrillator: primary results of the REMOTE-CIED randomized trial
AbstractAimsThe European REMOTE-CIED study is the first randomized trial primarily designed to evaluate the effect of remote patient monitoring (RPM) on patient-reported outcomes in the first 2 years after implantation of an implantable cardioverter-defibrillator (ICD).Methods and resultsThe sample consisted of 595 European heart failure patients implanted with an ICD compatible with the Boston Scientific LATITUDE® RPM system. Patients were randomized to RPM plus a yearly in-clinic ICD check-up vs. 3 –6-month in-clinic check-ups alone. At five points during the 2-year follow-up, patients completed questionnaires ...
Source: Europace - June 5, 2019 Category: Cardiology Source Type: research

Efficacy of catheter ablation for atrial fibrillation in patients with congenital heart disease
ConclusionWhile ablation may be a valid option for the treatment of AF in CHD patients, multiple procedures are likely to be required. Early referral and careful patient selection are essential to optimize the results of AF ablation, achieving a low rate of recurrence. Further studies are needed to validate our prognostic model and guide clinical practice. (Source: Europace)
Source: Europace - June 5, 2019 Category: Cardiology Source Type: research

Lyme carditis atrioventricular block: management strategies —Authors’ reply
We would like to thank Crinionet al.1 at Queen ’s university for their interest in our case report2 and for taking the time to contribute to the discussion. Crinionet al.1 discusses the role of permanent pacing in Lyme carditis and puts forth a systematic approach in such cases. (Source: Europace)
Source: Europace - June 5, 2019 Category: Cardiology Source Type: research

Lyme carditis atrioventricular block: management strategies
We read with great interest the recently published case report by Isathet al.1 entitled; ‘Leadless pacemaker used as long-term temporary therapy in Lyme carditis with high-grade atrioventricular block’. They report a novel pacing strategy to manage the unpredictable recovery of the cardiac conduction system in Lyme disease. Increased detection and climate factors have resulted in a marked increase in the global incidence of Lyme disease.2 However, pacing guidelines have yet to adequately address these challenging cases. Our device clinic is located in South Eastern Ontario, the region which reports the highest ...
Source: Europace - June 5, 2019 Category: Cardiology Source Type: research

Long-term single-centre large volume experience with transseptal endocardial left ventricular lead implantation
AbstractAimsThe aim of our study was to investigate the long-term efficacy and safety of transseptal endocardial left ventricular lead implantation (TELVLI).Methods and resultsTransseptal endocardial left ventricular lead implantation was performed in 54 patients (44 men, median age 69, New York Heart Association III –IV stage) between 2007 and 2017 in a single centre. In 36 cases, the transseptal puncture (TP) was performed via the femoral vein, and in 18 cases, the TP and also the left ventricular (LV) lead placement were performed via the subclavian vein. An electrophysiological deflectable catheter was use d to r...
Source: Europace - June 5, 2019 Category: Cardiology Source Type: research

A case of wide complex tachycardia with regular fusion beats
A 90-year-old man was admitted with palpitation and chest tightness for 2 h. He was known to have persistent atrial fibrillation (AF) and had a single chamber pacemaker (VVIR) implantation 9 years ago. His echocardiogram, about a year ago, showed moderate left ventricular dysfunction and moderate aortic stenosis. (Source: Europace)
Source: Europace - June 3, 2019 Category: Cardiology Source Type: research

Time-to-isolation-guided cryoballoon ablation reduces oesophageal and mediastinal alterations detected by endoscopic ultrasound: results of the MADE-PVI trial
ConclusionThe present prospective study demonstrates a significant impact of freeze protocol on oesophago-mediastinal alterations. A TTI-guided protocol reduces mediastino-oesophageal lesions and may reduce short- and long-term complications of cryoballoon PVI. (Source: Europace)
Source: Europace - May 29, 2019 Category: Cardiology Source Type: research

Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: best practice and real-world experience
ConclusionWith adherence to a standardized protocol and established exclusion criteria CMR imaging could safely be performed in patients with a CIED. The potential risks of device malfunction necessitate the presence of a device trained individual during the entire CMR examination. If there is a history of VT storm the attendance of an experienced cardiologist, should be mandatory. (Source: Europace)
Source: Europace - May 25, 2019 Category: Cardiology Source Type: research

Age-related regulation and region-specific distribution of ion channel subunits promoting atrial fibrillation in human left and right atria
Conclusion  Features of electrical remodelling in man occur in a qualitatively similar manner in both human atria. Age-related miR-328 dysregulation and reducedICa,L may contribute to increased AF susceptibility with age. (Source: Europace)
Source: Europace - May 25, 2019 Category: Cardiology Source Type: research

Machine learning in ‘big data’: handle with care
This commentary refers to ‘A novel atrial fibrillation prediction model for Chinese subjects: a nationwide cohort investigation of 682 237 study participants with random forest model’, by W.-S. Huet al., on pages 1307--1312. (Source: Europace)
Source: Europace - May 18, 2019 Category: Cardiology Source Type: research

Harnessing big data for identifying atrial fibrillation
This commentary refers to ‘A novel atrial fibrillation prediction model for Chinese subjects: a nationwide cohort investigation of 682 237 study participants with random forest model’, by W.-S. Huet al., on pages 1307--1312. (Source: Europace)
Source: Europace - May 18, 2019 Category: Cardiology Source Type: research

A cellular model of Brugada syndrome with SCN10A variants using human-induced pluripotent stem cell-derived cardiomyocytes
ConclusionPatient-specific hiPSC-CMs are able to recapitulate single-cell phenotype features of BrS withSCN10A mutations and may provide novel opportunities to further elucidate the cellular disease mechanism. (Source: Europace)
Source: Europace - May 18, 2019 Category: Cardiology Source Type: research

Agreement between gadolinium-enhanced cardiac magnetic resonance and electro-anatomical maps in patients with non-ischaemic dilated cardiomyopathy and ventricular arrhythmias
AbstractAimsWe sought to investigate the overlap between late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) and electro-anatomical maps (EAM) of patients with non-ischaemic dilated cardiomyopathy (NIDCM) and how it relates with the outcomes after catheter ablation of ventricular arrhythmias (VA).Methods and resultsWe identified 50 patients with NIDCM who received CMR and ablation for VA. Late gadolinium enhancement was detected in 16 (32%) patients, mostly in those presenting with sustained ventricular tachycardia (VT): 15 patients. Low-voltage areas (
Source: Europace - May 18, 2019 Category: Cardiology Source Type: research

Corrigendum to: Goldenberg I, et al. Risk of death without appropriate defibrillator shock in patients with advanced renal dysfunction
[Europace 2019;21:459 –464] (Source: Europace)
Source: Europace - May 18, 2019 Category: Cardiology Source Type: research

Deep sedation for transvenous lead extraction: a large single-centre experience
ConclusionTransvenous lead extraction under DS in the EP laboratory is a safe procedure with high success rates when performed by experienced staff. (Source: Europace)
Source: Europace - May 18, 2019 Category: Cardiology Source Type: research

2019 HRS/EHRA/APHRS/LAHRS focused update to 2015 expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing
AbstractThe2015 HRS/EHRA/APHRS/SOLAECE Expert Consensus Statement on Optimal Implantable Cardioverter-De fibrillator Programming and Testing provided guidance on bradycardia programming, tachycardia detection, tachycardia therapy, and defibrillation testing for implantable cardioverter-de fibrillator (ICD) patient treatment. The 32 recommendations represented the consensus opinion of the writing group, graded by Class of Recommendation and Level of Evidence. In addition, Appendix B provided manufacturer-specific translations of these recommendations into clinical practice consistent with the recommendations within the pa...
Source: Europace - May 15, 2019 Category: Cardiology Source Type: research

A visually striking calcific band causing monomorphic ventricular tachycardia as a first presentation of constrictive pericarditis
Constrictive pericarditis is a rare condition caused by thickening and stiffening of the pericardium manifesting in diastolic dysfunction and enhanced interventricular dependence. (Source: Europace)
Source: Europace - May 15, 2019 Category: Cardiology Source Type: research

Implantable cardioverter-defibrillators and survival in advanced heart failure patients with continuous-flow left ventricular assist devices: a systematic review and meta-analysis
ConclusionImplantable cardioverter-defibrillator use was not associated with improved survival in advanced HF patients with CF-LVADs. These findings underscore the need to formally study the efficacy of ICDs in this population in a dedicated randomized controlled study. (Source: Europace)
Source: Europace - May 13, 2019 Category: Cardiology Source Type: research

High resolution map of aortic root tachycardia
A 63-year-old woman without structural heart disease was referred with frequent, sustained episodes of atrial tachycardia. The episodes had terminated spontaneously before vagal manoeuvres or acute pharmacological intervention could be tried. Tachycardia with a cycle length 390 –420 ms was induced. High-density electroanatomic mapping using the Carto mapping system and a pentaray mapping catheter revealed earliest right atrial activation close to the His bundle. The earliest left atrial activation was in an adjacent position at similar timing, but mapping in the aortic root revealed earlier activation than obt...
Source: Europace - May 11, 2019 Category: Cardiology Source Type: research

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
AbstractVentricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for ...
Source: Europace - May 10, 2019 Category: Cardiology Source Type: research

Optimum lesion set and predictors of outcome in persistent atrial fibrillation ablation: a meta-regression analysis
Conclusion  Linear ablation, PWI, and CFAE ablation improves intraprocedural AF termination, but such termination does not predict better long-term outcomes. Study arms including PWI or LAA isolation in the lesion set were associated with improved outcomes in terms of freedom from AF; however, further randomized trials are required before these can be routinely recommended. Left atrial size is the most important marker of AF chronicity influencing outcomes. (Source: Europace)
Source: Europace - May 9, 2019 Category: Cardiology Source Type: research

Evaluation of a simple technique aiming at optimizing point-by-point isolation of the left pulmonary veins: a randomized study
AbstractAimsWe sought to evaluate the efficacy and the safety of a simple technique for stabilizing the ablation catheter during anterior pulmonary vein (PV) encirclement in patients ablated for paroxysmal atrial fibrillation. This consisted of bending the ablation catheter in the left atrium, creating a loop that was cautiously advanced together with the long sheath at the ostium and then within the left superior PV. The curve was then progressively released to reach a stable contact with the anterior part of the left PVs.Methods and resultsEighty consecutive patients (age 64  ± 11 years, left ...
Source: Europace - May 5, 2019 Category: Cardiology Source Type: research

Atrial fibrillation screening with photo-plethysmography through a smartphone camera
AbstractAimsThis cross-sectional study was set up to assess the feasibility of mass screening for atrial fibrillation (AF) with only the use of a smartphone.Methods and resultsA local newspaper published an article, allowing to subscribe for a 7-day screening period to detect AF. Screening was performed through an application that uses photo-plethysmography (PPG) technology by exploiting a smartphone camera. Participants received instructions on how to perform correct measurements twice daily, with notifications pushed through the application ’s software. In case of heart rhythm irregularities, raw PPG signals underw...
Source: Europace - May 5, 2019 Category: Cardiology Source Type: research

Non-paroxysmal atrial fibrillation mapping: characterization of the electrophysiological substrate using a novel integrated mapping technique
AbstractAimsClinical outcomes after radiofrequency catheter ablation (RFCA) remain suboptimal in the treatment of non-paroxysmal atrial fibrillation (AF). Electrophysiological mapping may improve understanding of the underlying mechanisms. To describe the arrhythmia substrate in patients with persistent (Pers) and long-standing persistent (LSPers) AF, undergoing RFCA, using an integrated mechanism mapping technique.Methods and resultsPatients underwent high-density electroanatomical mapping before and after catheter ablation. Integrated maps characterized electrogram (EGM) cycle length (CL) in regions with repetitive &ndas...
Source: Europace - May 5, 2019 Category: Cardiology Source Type: research

Electrocardiographic optimization techniques in resynchronization therapy
AbstractCardiac resynchronization therapy (CRT) is a cornerstone of therapy for patients with heart failure, reduced left ventricular (LV) ejection fraction, and a wide QRS complex. However, not all patients respond to CRT: 30% of CRT implanted patients are currently considered clinical non-responders and up to 40% do not achieve LV reverse remodelling. In order to achieve the best CRT response, appropriate patient selection, device implantation, and programming are important factors. Optimization of CRT pacing intervals may improve results, increasing the number of responders, and the magnitude of the response. Echocardio...
Source: Europace - April 30, 2019 Category: Cardiology Source Type: research

Left subclavian approach for ablation of persistent left superior vena cava in a patient with cardiac resynchronization therapy: a case report
Persistent left superior vena cava (PLSVC) causes arrhythmogenicity in atrial fibrillation (AF). However, in patients with cardiac resynchronization therapy (CRT), PLSVC ablation through the coronary sinus (CS) risks left ventricular (LV) lead dislodgement. (Source: Europace)
Source: Europace - April 29, 2019 Category: Cardiology Source Type: research

The effect of implantable cardioverter-defibrillator in patients with diabetes and non-ischaemic systolic heart failure
ConclusionAmong patients with non-ischaemic systolic HF, diabetes was associated with higher incidence of all-cause mortality, primarily driven by cardiovascular mortality including SCD. Treatment effect of ICD therapy was not significantly modified by diabetes which might be due to lack of power. (Source: Europace)
Source: Europace - April 28, 2019 Category: Cardiology Source Type: research

Incidence of appropriate implantable cardioverter-defibrillator therapy and mortality after implantable cardioverter-defibrillator generator replacement: results from a real-world nationwide cohort
ConclusionA significant residual risk of appropriate therapy in the 2nd generator was present even among patients with advanced age and with a full prior generator period without any appropriate ICD events. (Source: Europace)
Source: Europace - April 27, 2019 Category: Cardiology Source Type: research

Molecular and genetic insights into progressive cardiac conduction disease
AbstractProgressive cardiac conduction disease (PCCD) is often a primarily genetic disorder, with clinical and genetic overlaps with other inherited cardiac and metabolic diseases. A number of genes have been implicated in PCCD pathogenesis with or without structural heart disease or systemic manifestations. Precise genetic diagnosis contributes to risk stratification, better selection of specific therapy and allows familiar cascade screening. Cardiologists should be aware of the different phenotypes emerging from different gene-mutations and the potential risk of sudden cardiac death. Genetic forms of PCCD often overlap o...
Source: Europace - April 26, 2019 Category: Cardiology Source Type: research

A novel atrial fibrillation prediction model for Chinese subjects: a nationwide cohort investigation of 682  237 study participants with random forest model
ConclusionsThis study showed a novel AF risk prediction scheme for Chinese individuals with random forest model methodology. (Source: Europace)
Source: Europace - April 23, 2019 Category: Cardiology Source Type: research

Long-term results of atrial maze surgery in patients with congenital heart disease
ConclusionMaze procedure at the time of an elective anatomic surgery is reasonably effective to prevent and treat atrial arrhythmias in patients with congenital heart disease at short- and mid-term, with low morbidity and mortality. (Source: Europace)
Source: Europace - April 19, 2019 Category: Cardiology Source Type: research

Impact of transcatheter mitral valve repair on ventricular arrhythmias
ConclusionsIn this prospective study, transcatheter mitral valve repair using MitraClip was associated with a reduced prevalence of ventricular arrhythmias. The subset of patients with persistent or new ventricular arrhythmias after MitraClip implantation showed progression of left ventricular dysfunction. (Source: Europace)
Source: Europace - April 16, 2019 Category: Cardiology Source Type: research

QT prolongation predicts short-term mortality independent of comorbidity
AbstractAimsA prolonged corrected QT interval (QTc) ≥500 ms is associated with high all-cause mortality in hospitalized patients. We aimed to explore any difference in short- and long-term mortality in patients with QTc ≥500 ms compared with patients with QTc
Source: Europace - April 8, 2019 Category: Cardiology Source Type: research

End-of-service management of leadless cardiac pacemakers: a case report
A 90-year-old man had been implanted with a leadless pacemaker (Micra VR transcatheter pacing system, Medtronic, Minneapolis, MN, USA) for a complete atrioventricular block in 2016. At implantation, in a right ventricular apical position, pacing threshold was 0.63  V at a 0.24 ms pulse width, with an expected battery longevity>10  years. (Source: Europace)
Source: Europace - March 26, 2019 Category: Cardiology Source Type: research

Bidirectional ventricular tachycardia in ACTH-producing pheochromocytoma
(Source: Europace)
Source: Europace - March 20, 2019 Category: Cardiology Source Type: research

Left pulmonary cusp ablation of refractory ventricular arrhythmia originating from the inaccessible summit
A 39-year-old female patient who had undergone two extensive radiofrequency (RF) catheter ablations of premature ventricular complexes (PVC) originating from the inaccessible left ventricular summit (LVS) was referred for a third procedure. Mapping of the anterior interventricular vein (AIV) performed by using a steerable catheter confirmed the earliest activation of the PVC in the inaccessible area of the LVS (Figure). Any RF ablation at that earliest site was impossible to use due to the direct proximity of the LAD. With reversed U-shaped technique, a second regular 4 mm ablation catheter (AC) showed very similar PVC act...
Source: Europace - March 8, 2019 Category: Cardiology Source Type: research