Urine albumin excretion and the risk of incident atrial fibrillation: predictive or aetiological relevance —Authors' reply
We appreciate the continuing interest of Abbasi1 in the PREVEND cohort. Our article showed that in a community-based cohort increased albumin excretion, and not estimated glomerular filtration rate, was associated with incident AF, even after adjustments for established cardiovascular risk factors.2 We agree that we cannot rule out unmeasured confounding or reverse causality. Theoretically, a randomized controlled trial or Mendelian randomization may be approaches to provide more causal evidence.3 However, the Mendelian randomization as brought forward based on GWAS variants are also not immune against unmeasured confoundi...
Source: Europace - June 10, 2017 Category: Cardiology Source Type: research

Supraventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy associate with long-term outcome after catheter ablation of ventricular tachycardias
ConclusionSVT and older age are associated with the recurrence of VT after catheter ablation in patients with ARVD/C. (Source: Europace)
Source: Europace - June 7, 2017 Category: Cardiology Source Type: research

Cardiac resynchronization therapy and electrical storm: results of the OBSERVational registry on long-term outcome of ICD patients (OBSERVO-ICD)
ConclusionPatients with CRT had a lower incidence of ES when compared with propensity-matched ICD patients. The long-term benefit of CRT seems to be due to the improved haemodynamics, as CRT-responders performed markedly better over a long-term follow-up. (Source: Europace)
Source: Europace - June 7, 2017 Category: Cardiology Source Type: research

Suggestions for clinical studies on percutaneous left atrial appendage occlusion: authors' reply
The Munich consensus document is a physician-initiated effort to establish better and more consistent methodology for studies related to percutaneous left atrial appendage occlusion (LAAO).1 The document is endorsed by EHRA, EAPCI, and other professional societies. The proposed definitions and endpoints for data collection are based on the available published data, and pertinent clinical experience. Our group aimed to provide meaningful definitions and to recommend data collection strategies that are both clinically relevant and feasible. We would like to thank the authors for their letter.2 Herein, we try to reply to all ...
Source: Europace - June 7, 2017 Category: Cardiology Source Type: research

Proteomics of the epicardial fat secretome and its role in post-operative atrial fibrillation
ConclusionFor the first time we describe EAT secretome as a possible substrate for POAF. It contains various proteins differentially expressed in patients who later develop POAF. Amongst those gelsolin, involved in inflammation and ion channel regulation, was associated with maintenance of sinus rhythm. Understanding the role of EAT may offer novel insights into prevention and treatment of AF. (Source: Europace)
Source: Europace - June 5, 2017 Category: Cardiology Source Type: research

Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling: results from the MARC study – authors reply
We thank Stankovic and Voigt1 for their interest in our study2 and agree that the identification of apical rocking as an independent predictor of response to cardiac resynchronization therapy (CRT) in the MARC study is not a new finding.3 (Source: Europace)
Source: Europace - June 5, 2017 Category: Cardiology Source Type: research

Comparison of epicardial vs. endocardial reimplantation in pacemaker-dependent patients with device infection
ConclusionWe observed similar in-hospital outcomes in our EPI and TP cohorts. Twenty-five percent of the patients initially paced by a TP strategy finally needed an epicardial device, mainly because of infection of their TP lead. Use of TP resulted in lower rates of late endocarditis and device reintervention. (Source: Europace)
Source: Europace - June 3, 2017 Category: Cardiology Source Type: research

A case of removal of a “dancing” Micra
Micra ™ (Medtronic Inc) transcatheter pacing system (TPS) late removal raises a concern since the absence of a specialized tool system and the possibility of early endothelialization. (Source: Europace)
Source: Europace - June 3, 2017 Category: Cardiology Source Type: research

Comparison of the effects of selective and non-selective His bundle pacing on cardiac electrical and mechanical synchrony
ConclusionSelective His bundle pacing and high-output NS-HBP could restore normal electrical and LV mechanical synchrony. (Source: Europace)
Source: Europace - May 31, 2017 Category: Cardiology Source Type: research

Ultrasound-guided versus conventional femoral venipuncture for catheter ablation of atrial fibrillation: a multicentre randomized efficacy and safety trial (ULTRA-FAST trial)
AbstractAimsComplications of catheter ablation for atrial fibrillation (AF) are frequently related to vascular access. We hypothesized that ultrasound-guided (USG) venipuncture may facilitate the procedure and reduce complication rates.Methods and resultsWe conducted a multicentre, randomized trial in patients undergoing catheter ablation for AF on uninterrupted anticoagulation therapy. The study enrolled consecutive 320 patients (age: 63  ± 8 years; male: 62%) and were randomized to USG or conventional venipuncture in 1:1 fashion. It was prematurely terminated due to substantially lower-than-ex...
Source: Europace - May 30, 2017 Category: Cardiology Source Type: research

Corrigendum
to: Outcomes of atrial arrhythmia radiofrequency catheter ablation in patients with Ebstein ’s anomaly [Europace 2018;20:525 –30] (Source: Europace)
Source: Europace - May 30, 2017 Category: Cardiology Source Type: research

Recognition of short RP atrial tachycardia due to intra-atrial conduction delay: utility of a septal AH/HA Ratio & lt;1
A 59-year-old man underwent ablation for cavotricuspid (CTI)-dependent right atrial flutter. Post ablation programmed stimulation reproducibly initiated supraventricular tachycardia with a cycle length 300 –310 ms. The rhythm strip showed short RP tachycardia with a prolonged P wave duration (175 ms), which was much longer compared with during sinus rhythm (110 ms) (top panel, left). (Source: Europace)
Source: Europace - May 30, 2017 Category: Cardiology Source Type: research

Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: systematic review and meta-analysis
ConclusionIn patients with SHD who had VT related mainly to ischaemic substrates, there was a significantly lower risk of the composite primary outcome of long-term VA recurrence and all-cause mortality among those undergoing substrate modification compared to standard ablation. Long-term success is improved when performing complete substrate modification. (Source: Europace)
Source: Europace - May 26, 2017 Category: Cardiology Source Type: research

Peritoneal migration of an epicardial pacemaker
A newborn with complete congenital atrioventricular block of immune origin, in severe heart failure, was implanted with a pacemaker at 1 day of life. The pacing lead was fixed to the epicardial right ventricle and the generator conventionally implanted in a pocket created beneath rectus muscles. (Source: Europace)
Source: Europace - May 25, 2017 Category: Cardiology Source Type: research

Family history of atrial fibrillation as a predictor of atrial substrate and arrhythmia recurrence in patients undergoing atrial fibrillation catheter ablation
ConclusionThe presence of a 1st-degree family member with AF does not impact the clinical outcomes of catheter ablation for paroxysmal AF. However, a positive family history is associated with worse arrhythmia free survival in patients with PeAF. This finding is not explained by differences in clinical characteristics, atrial substrate assessed by voltage maps or ablation characteristics. (Source: Europace)
Source: Europace - May 24, 2017 Category: Cardiology Source Type: research

Current management and clinical outcomes for catheter ablation of atrioventricular nodal re-entrant tachycardia
ConclusionIn a large, contemporary cohort, catheter ablation for AVNRT remains highly successful with low complications rates. The increased use of anaesthesia as well as modern mapping and ablation tools were not associated with changes in clinical outcomes. Further prospective evaluation of such contemporary practices is warranted given the lack of evidence to support their escalating use. (Source: Europace)
Source: Europace - May 24, 2017 Category: Cardiology Source Type: research

The effects of gender on electrical therapies for the heart: physiology, epidemiology, and access to therapies
AbstractThe difference between men and women is clear even just by looking at an electrocardiogram: females present higher resting heart rate, a shorter QRS complex length and greater corrected QT interval. The development of these differences from pubertal age onward suggests that sexual hormones play a key role, although their effect is far from being completely understood. Different incidences between sexes have been reported for many arrhythmias, both ventricular and supraventricular, and also for sudden cardiac death. Moreover, arrhythmias are an important issue during pregnancy, both for diagnosis and treatment. Inte...
Source: Europace - May 19, 2017 Category: Cardiology Source Type: research

A new electrogram-based diagnostic algorithm to improve the left ventricular effective pacing detection corrected a non-response to cardiac resynchronization therapy pacing
We present a case of a 79-year-old male, non-responder to cardiac resynchronization therapy (CRT) despite the classic pacing counters indicating 99.3% biventricular (BiV) pacing. A new EGM-based diagnostic algorithm was used to uncover poor delivery of CRT pacing. The left ventricle (LV) cathode –right ventricle (RV) Coil electrogram (EGM) corresponding to each paced beat was analysed by the algorithm which automatically determined if the EGM had a QS/QS-r morphology and accordingly classified the paced beat as effective or ineffective. If CRT pacing is effective, the electrogram recorded from the pacing site should ...
Source: Europace - May 19, 2017 Category: Cardiology Source Type: research

Shortening of the atrial-His bundle interval during atrial pacing as a predictor of successful ablation for typical atrioventricular nodal re-entrant tachycardia
AbstractAimsShortening of the atrial-His bundle (AH) interval during the sinus rhythm is occasionally observed after slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT). In addition, high-rate atrial pacing is useful for avoiding atrioventricular block. We hypothesized that shortening of the AH interval during slow pathway ablation under high-rate atrial pacing would lead to successful ablation of typical AVNRT.Methods and resultsThis retrospective study included 37 patients in whom successful ablation of typical AVNRT was performed under atrial pacing. The AH interval was measured immediately b...
Source: Europace - May 17, 2017 Category: Cardiology Source Type: research

Management of untreatable ventricular arrhythmias during pharmacologic challenges with sodium channel blockers for suspected Brugada syndrome
AbstractPharmacologic challenge with sodium channel blockers is part of the diagnostic workout in patients with suspected Brugada syndrome. The test is overall considered safe but both ajmaline and flecainide detain well known pro-arrhythmic properties. Moreover, the treatment of patients with life-threatening arrhythmias during these diagnostic procedures is not well defined. Current consensus guidelines suggest to adopt cautious protocols interrupting the sodium channel blockers as soon as any ECG alteration appears. Nevertheless, the risk of life-threatening arrhythmias persists, even adopting a safe and cautious protoc...
Source: Europace - May 17, 2017 Category: Cardiology Source Type: research

Dabigatran vs. warfarin in relation to the presence of left ventricular hypertrophy in patients with atrial fibrillation — the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) study
ConclusionsLVH was associated with a lower antithrombotic efficacy of warfarin, but not of dabigatran, in patients with AF. Consequently, the relative benefit of the lower dose of dabigatran compared to warfarin was enhanced in patients with LVH. The higher dose of dabigatran was superior to warfarin regardless of LVH status.Clinical trial registrationhttp:www.clinicaltrials.gov. Unique identifier: NCT00262600. (Source: Europace)
Source: Europace - May 17, 2017 Category: Cardiology Source Type: research

The effects of gender on electrical therapies for the heart: procedural considerations, results and complications A report from the XII Congress of the Italian Association on Arrhythmology and Cardiostimulation (AIAC)
AbstractUse of cardiac implantable devices and catheter ablation is steadily increasing in Western countries following the positive results of clinical trials. Despite the advances in scientific knowledge, tools development, and techniques improvement we still have some grey area in the field of electrical therapies for the heart. In particular, several reports highlighted differences both in medical behaviour and procedural outcomes between female and male candidates. Women are referred later for catheter ablation of supraventricular arrhythmias, especially atrial fibrillation, leading to suboptimal results. On the opposi...
Source: Europace - May 17, 2017 Category: Cardiology Source Type: research

Non-laser percutaneous extraction of pacemaker and defibrillation leads: a decade of progress
AbstractAimsNon-laser-based methods are safe in lead extraction but in the past have been less effective than laser methods. In the past decade, new equipment has been introduced including the Evolution ® Mechanical Dilator Sheath and the Evolution® RL. We sought to determine the impact of new equipment on outcome in mechanical lead extraction.Methods and resultsWe considered 288 consecutive patients (age 66 ± 18 years) who underwent transvenous lead extraction (TLE) of 522 leads in the decade to the end of 2014. Three groups were identified: Group 1 (pre-Evolution® period, 76 patients, 133 leads), Group...
Source: Europace - May 17, 2017 Category: Cardiology Source Type: research

Severe conduction defects requiring permanent pacemaker implantation in patients with a new-onset left bundle branch block after transcatheter aortic valve implantation
ConclusionThe severity and persistence of a new-onset LBBB after TAVI is associated with mortality. Cardiac conduction defects requiring PPI are associated with prior AF, the use of digoxin, CoreValve implantation, and a left heart axis. In these patients, PPI portends a better prognosis than no PPI. (Source: Europace)
Source: Europace - May 17, 2017 Category: Cardiology Source Type: research

Presyncopal episodes after implantation of dual-chamber pacemaker programmed in SafeR pacing mode
[Europace 2017, doi:10.1093/europace/euw440] (Source: Europace)
Source: Europace - May 16, 2017 Category: Cardiology Source Type: research

Atrial fibrillation: a left atrial neuro-myopathy?
This editorial refers to ‘Longitudinal association of short-term, metronome-paced heart rate variability and echocardiographically assessed cardiac structure at a 4-year follow-up: results from the prospective, population-based CARLA cohort’ by D. Medenwaldet al., on pages2027 –2035. (Source: Europace)
Source: Europace - May 15, 2017 Category: Cardiology Source Type: research

Automatic remote monitoring utilizing daily transmissions: transmission reliability and implantable cardioverter defibrillator battery longevity in the TRUST trial
AbstractAimsBenefits of automatic remote home monitoring (HM) among implantable cardioverter defibrillator (ICD) patients may require high transmission frequency. However, transmission reliability and effects on battery longevity remain uncertain. We hypothesized that HM would have high transmission success permitting punctual guideline based follow-up, and improve battery longevity. This was tested in the prospective randomized TRUST trial.Methods and resultsImplantable cardioverter defibrillator patients were randomized post-implant 2:1 to HM (n = 908) (transmit daily) or to Conventional in-person monitorin...
Source: Europace - May 10, 2017 Category: Cardiology Source Type: research

An atypical roof-dependent atrial tachycardia with a long channel of conduction identified with high-density mapping: pitfall of the conventional assessment of the roof line block
A 60-year-old woman presented for radiofrequency (RF) ablation of an atrial tachycardia (AT) after initial atrial fibrillation (AF) ablation. At the time of the electrophysiological study, the patient was in AT (CL = 245 ms). An activation map with the OrionTM basket catheter and the RhythmiaTM system (Boston Scientific, USA) displayed a dual-loop macro-re-entrant AT with roof-dependent and peri-mitral circuits. RF application to the mitral isthmus terminated the AT with the end point of bidirectional block. Subsequently, we completed the roof line and confirmed block while pacing the left atrial appendage (LAA); the durat...
Source: Europace - May 7, 2017 Category: Cardiology Source Type: research

Long-term clinical impact of permanent cardiac pacing after transcatheter aortic valve implantation with the CoreValve prosthesis: a single center experience
ConclusionPatients requiring a PPM after TAVI did not have an increase in mortality, or an increase in the likelihood of developing a stroke at a long-term follow-up. However, this subgroup of patients showed an increase in rehospitalization due to HF at medium- and long-term follow-up. (Source: Europace)
Source: Europace - May 4, 2017 Category: Cardiology Source Type: research

Successful catheter ablation of ventricular ectopy in a young patient with implanted Melody valve
A 17-year-old male after transcatheter implantation of Melody pulmonary valve (TPV) (Medtronic) was admitted for catheter ablation (CA) of frequent and highly symptomatic premature ventricular complexes (PVCs —Figure) refractory to treatment with bisoprolol. The patient had a history of surgical correction of truncus arteriosus. Due to moderate stenosis and severe regurgitation of the valved conduit, a TPV Melody was implanted and was functioning properly at the time of the procedure. Morphology of PVC s implied origin from the right ventricular outflow tract. (Source: Europace)
Source: Europace - May 4, 2017 Category: Cardiology Source Type: research

Suggestions for clinical studies about percutaneous left atrial appendage occlusion
With great interest, we read the Munich consensus document on definitions, endpoints, and data collection for clinical studies about percutaneous left atrial appendage occlusion (LAAO).1 The authors have to be congratulated for their effort to standardize the definitions and to propose a consistent approach in the reporting of LAAO studies. However, regarding the sequelae of LAAO the following questions and concerns arise. (Source: Europace)
Source: Europace - May 2, 2017 Category: Cardiology Source Type: research

Sinkhole syncope
(Source: Europace)
Source: Europace - May 2, 2017 Category: Cardiology Source Type: research

Prognostic value of elevated high-sensitivity cardiac troponin T in patients admitted to an emergency department with atrial fibrillation
AbstractAimsElevated levels of high-sensitivity cardiac troponin T (hsTnT) indicate underlying heart disease and are known to predict adverse outcomes in various patient populations. Their role in atrial fibrillation (AF) is still under debate.Methods and resultsThis retrospective study included 2898 consecutive patients presenting with AF to the emergency department of the Department of Cardiology, Heidelberg University Hospital. Multivariable Cox regression was used to assess associations between hsTnT and mortality. Elevated hsTnT levels were associated with increased risk of all-cause mortality in all patients with AF,...
Source: Europace - April 27, 2017 Category: Cardiology Source Type: research

Non-vitamin K-dependent oral anticoagulants have a positive impact on ischaemic stroke severity in patients with atrial fibrillation
AbstractAimsSeveral studies showed reduced stroke severity in patients with atrial fibrillation (AF) if the international normalized ratio (INR) was ≥ 2 at stroke onset. There are no respective data for non-vitamin K-dependent oral anticoagulants (NOACs). The aim of this study was to compare the impact of NOAC or phenprocoumon intake on stroke severity.Methods and resultsIn this single-centre observational study, 3669 patients with acute ischaemic stroke were retrospectively analysed regarding AF status and medication immediately before admission. Using multivariable regression, we analysed the association of pre...
Source: Europace - April 27, 2017 Category: Cardiology Source Type: research

Vernakalant does not alter early repolarization or contractility in normal and electrically remodelled atria
ConclusionIn goat atria, vernakalant does not have an atrial positive inotropic effect and does not affect early repolarization. At high rates vernakalant may even have a negative inotropic effect. (Source: Europace)
Source: Europace - April 25, 2017 Category: Cardiology Source Type: research

Surface electrocardiography characteristics and radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from the left infero-septal papillary muscles: differences from those originating from the left posterior fascicle
ConclusionPM ventricular arrhythmias could be identified from LPF ventricular arrhythmias by calculation of QRS duration combined withVi/Vt using ECG. (Source: Europace)
Source: Europace - April 24, 2017 Category: Cardiology Source Type: research

Reappraisal and new observations on atrial tachycardia ablated from the non-coronary aortic sinus of Valsalva: authors' reply
We thank Madaffari and his colleagues for the interest in our recent publication inEuropace regarding the ablation of atrial tachycardias from the non-coronary sinus of the aortic root.1 Perhaps the key statement in their letter reads ‘We agree with the analysis done by Markowitz’. The ‘analysis’ performed by Markowitz,2 however, was an editorial commentary on the investigation performed by Pap and colleagues, to which Madaffari and his associates also refer.3 In his ‘analysis’, Markowitz makes the key statement that ‘a detailed understanding of anatomic relationships can suggest n...
Source: Europace - April 24, 2017 Category: Cardiology Source Type: research

Improved outcome and cost effectiveness in ablation of persistent atrial fibrillation under general anaesthetic
ConclusionsIn patients with persistent AF, it is both clinical and economically more effective to perform ablation under GA rather than sedation. (Source: Europace)
Source: Europace - April 21, 2017 Category: Cardiology Source Type: research

Catheter ablation for ventricular tachycardia in patients with cardiac sarcoidosis: a systematic review
AbstractAimsCardiac sarcoidosis (CS) is associated with a poor prognosis. Important features of CS include heart failure, conduction abnormalities, and ventricular arrhythmias. Ventricular tachycardia (VT) is often refractory to antiarrhythmic drugs (AAD) and immunosuppression. Catheter ablation has emerged as a treatment option for recurrent VT. However, data on the efficacy and outcomes of VT ablation in this context are sparse.Methods and resultsA systematic search was performed on PubMed, EMBASE, and Cochrane database (from inception to September 2016) with included studies providing a minimum of information on CS pati...
Source: Europace - April 21, 2017 Category: Cardiology Source Type: research

Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis
ConclusionsPatients with AF recurrence following RFA have a higher mean LAV/LAVi compared to patients with no recurrence. Large LAV/LAVi increases the odds of AF recurrence post RFA. (Source: Europace)
Source: Europace - April 21, 2017 Category: Cardiology Source Type: research

Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation: follow-up results from a prospective observational study
AbstractAimsCardiac Resynchronization Therapy (CRT) is associated with a particularly high non-response rate in patients with atrial fibrillation (AF). We aimed to assess the effectiveness of triple-site (Tri-V) pacing CRT in this population.Methods and resultsProspective observational study of patients with permanent AF who underwent CRT implantation with an additional right ventricle lead in the outflow tract septal wall. After implantation, programming mode (Tri-V or biventricular pacing) was selected based on cardiac output determination. Patients were classified as responders if NYHA class was reduced by at least one ...
Source: Europace - April 19, 2017 Category: Cardiology Source Type: research

A devices ’ game of thrones: cardiac resynchronization therapy vs. pacemaker
ConclusionThis paper emphasizes the importance of knowing the distinct pacemaker brady mode behaviours after battery capacity depleted indicator has been reached, according to the pacemakers ’ manufacturer, including the possibility of automatic brady mode change from sensing to pacing mode. It also highlights the potential for severe bradycardia or asystole of this automatic brady mode change from a previously implanted pacemaker in pacemaker dependent patients submitted to CRT upgra de. (Source: Europace)
Source: Europace - April 18, 2017 Category: Cardiology Source Type: research

Vagal third-degree atrioventricular block in a highly trained endurance athlete
Electrocardiogram (ECG) characteristics of athletes have recently become a topic of intensive study. Athletes are well known to have low-heart rates, but it is difficult to determine how low is too low for pacemaker indication. (Source: Europace)
Source: Europace - April 18, 2017 Category: Cardiology Source Type: research

Visualizing induced silent steam pop with intracardiac echocardiography
A piglet underwent aggressively endocardial radiofrequency catheter ablation (RFCA) (FlexAbilityTM; St Jude Medical). RFCA was applied in the left ventricle. An intracardiac echocardiography catheter (ViewFlexTM, Xtra ICE Catheter; St Jude Medical) was inserted in the right ventricle (PanelA). Formation of focal microbubbles was observed before steam pop initiation. After 44 s from initiation of RFCA, a silent steam explosion occurred. Explosive microbubbles were clearly observed. The impedance tracing was not remarkable. The endocardial damage caused by this induced steam pop was a void 15  mm in diameter and 8 mm ...
Source: Europace - April 18, 2017 Category: Cardiology Source Type: research

Inappropriate sinus tachycardia in a heart transplant successfully treated with ivabradine
A 55-year-old male with history of two prior orthotopic heart transplants presented with his third heart failure hospitalization in 4 months with a steady decrement in left ventricular ejection fraction (LVEF) from 65% to 35%. During each hospitalization, he demonstrated a long-RP tachycardia in the 130 beats/min (Panel A). His tachycardia preceded the deterioration in LVEF. An extensive evaluation included a right heart catheterization showing elevated filling pressures, coronary angiography showing no epicardial coronary artery disease, and endomyocardial biopsies at two different times finding no evidence of allograft r...
Source: Europace - April 18, 2017 Category: Cardiology Source Type: research

Implantable cardioverter defibrillator use for primary prevention in ischaemic and non-ischaemic heart disease —indications in the post-DANISH trial era: results of the European Heart Rhythm Association survey
Implantable cardioverter-defibrillator (ICD) is the standard of care for prevention of sudden cardiac death (SCD) in high-risk patients. For primary prevention of SCD, in patients with ischaemic heart disease, there is more robust data on the effect of ICD therapy compared with patients with non-ischaemic heart disease, but current real-life practice may differ substantially. The aim of this European Heart Rhythm Association survey was to evaluate the clinical practice regarding implantation of ICD for primary prevention among European countries in patients with non-ischaemic and ischaemic heart disease. Furthermore, we wa...
Source: Europace - April 18, 2017 Category: Cardiology Source Type: research

Cryoballoon pulmonary vein isolation and lung lobectomy
(Source: Europace)
Source: Europace - April 18, 2017 Category: Cardiology Source Type: research

Cardioinhibitory and vasodepressor responses to different stressors on head-up tilt
We describe the case of a 37-year-old man with a history of laughter-induced syncope, which caused him to crash his car. The patient was a non-smoker with a history of obstructive sleep apnoea and obesity with a body mass index of 33.5. He underwent head up tilt testing with glyceryl trinitrate provocation. On four occasions, the patient was asked to laugh which all ended in a spontaneous vigorous cough after which he started to feel lightheaded. There was concordant drop in systolic BP without any decrease in heart rate (PanelA). At 32  min, there was sinus arrest for 12 seconds and loss of consciousness for...
Source: Europace - April 17, 2017 Category: Cardiology Source Type: research

Avoiding oesophageal injury during cardiac ablation: insights gained from mediastinal anatomy
ConclusionMediastinal anatomy, specifically the presence of a loose connective tissue that attaches the oesophagus to the parietal pericardium overlying the posterior LA wall will allow for a lateral displacement of the oesophagus. This should decrease or eliminate the likelihood of thermal injury of the oesophagus. Using an endotracheal stylet, we investigated the lateral displacement of the oesophagus in 11 human cadavers. In six with the stylet extending to the GE junction, the oesophagus was displaced a mean of 3.8  cm. In five, with stylet 4 cm cranial to the junction, the displacement was 4.56 cm. (Source: Europace)
Source: Europace - April 16, 2017 Category: Cardiology Source Type: research

Radiotherapy in a leadless pacemaker
In conclusion, in this first experience of RT in a patient with a leadless pace maker implanted within the radiation field, continuous monitoring of device rule out remarkable damage to the pacemaker, endorsing its potential use in patients with RT requirements. (Source: Europace)
Source: Europace - April 16, 2017 Category: Cardiology Source Type: research