Oral loading of propafenone: restoring its role before restoring rhythm —authors’ reply
We wish to thank Martignaniet al.1 for their critical Letter to the Editor according to our article recently published inEuropace2 where they question our proposal that propafenone should not be generally excluded from cardioversion of paroxysmal atrial fibrillation in patients with structural heart disease. Recent2016European Society of CardiologyGuidelines for the Management of Atrial Fibrillation3 support the use of propafenone for acute pharmacological cardioversion in patients with new onset of atrial fibrillation. However, their restriction that propafenone should only be given to patients without structural heart di...
Source: Europace - January 6, 2017 Category: Cardiology Source Type: research

Epsilon wave on an electronic loop in a case of arrhythmogenic right ventricular dysplasia with myocarditis: an updated definition of the Epsilon wave
AbstractA young man presented with a history of myocarditis with palpitations and dizziness. He had implantation of a loop recorder that showed repetitive short episodes of VT. In addition, there were fragmented potentials immediately following the large and sharp electrograms (EGMs) before as well as after episodes of VT suggesting an Epsilon wave. This signal can be observed in multiple cardiac conditions including coronary artery disease. It was originally recorded on the epicardium as well as on the endocardium. However, in ARVD it can be defined as an electric signal observed after the end of the QRS complex in the ri...
Source: Europace - January 6, 2017 Category: Cardiology Source Type: research

Catheter ablation for atrial flutter: a survey by the European Heart Rhythm Association and Canadian Heart Rhythm Society
It has been brought to the publisher's attention that the above paper was published twice with different DOIs. The correct version of the paper has DOI10.1093/europace/euw402 and was published in issue 18-12 of the journal. Kindly use this reference for the paper instead of10.1093/europace/euw392. (Source: Europace)
Source: Europace - January 5, 2017 Category: Cardiology Source Type: research

Concerns about the European Society of Cardiology atrial fibrillation guidelines: reply
We would like to thank you for taking the time to prepare a letter to the Editor of Europace recently, in which you express your thoughts on the matters of conflicts of interest. This letter has been forwarded to the senior leadership of the European Society of Cardiology (ESC), given the guidelines are those of the ESC. We felt you would appreciate a reply directly from us to address your questions. (Source: Europace)
Source: Europace - January 4, 2017 Category: Cardiology Source Type: research

Concerns about the European society of cardiology atrial fibrillation guidelines
With great interest we read the recent European Society of Cardiology (ESC) guidelines for the Management of Atrial Fibrillation.1 We are, however, concerned about the high number of conflicts of interest (COIs) of the authors as listed in theTable1. Of 17 authors only 2 (12%) indicated no COI. The chairperson of the task force had the second most COIs (n = 30). The mean number of COIs of all authors indicating any COI was 12.3. In the previous 2010 guidelines on atrial fibrillation 8 of 25 authors (32%) had no COI. The mean number of COIs of the authors indicating any COI was 8.2.2Table 1Declarations of inte...
Source: Europace - January 4, 2017 Category: Cardiology Source Type: research

Atrio-ventricular block from metastatic lung cancer to the aortic root
A 51-year-old man with stage IV squamous cell lung cancer presented with complete heart block and a left fascicular escape rhythm unresponsive to epinephrine therapy (PanelA). Echocardiography revealed a large, irregular 2.2 × 2.1 cm lung metastasis (arrows) to the right atrio-ventricular groove just opposite to the non-coronary cusp of the aortic valve and a globular left septal metastasis immediately beneath the right coronary cusp (PanelB). Herein is a rare case of lung carcinoma metastatic to the aortic root with invasion of the His-Purkinje system causing atrio-ventricular block and a fascicular escape rh...
Source: Europace - January 4, 2017 Category: Cardiology Source Type: research

Cardiac resynchronization therapy by multipoint pacing improves response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo study
ConclusionThese preliminary results suggest that MPP resulted in significant improvement of LV mechanics and fluid dynamics compared with BiV. However, larger studies are needed to confirm this hypothesis. (Source: Europace)
Source: Europace - December 26, 2016 Category: Cardiology Source Type: research

Catheter ablation reduces ventricular tachycardia burden in patients with arrhythmogenic right ventricular cardiomyopathy: insights from a north-western French multicentre registry
This study included 49 patients with ARVC (46 with definite diagnosis, 3 with borderline diagnosis according to revised Task Force Criteria) who underwent 92 RFA procedures (83 endocardial, 9 combined endo –epicardial) between 1999–2015. Ventricular tachycardia recurrences and VT burden were assessed after each procedure or after the last RFA. Over a mean follow-up of 64 ± 51 months, VT-free survival was 37% at 1 year, 19% at 5 years, and 14% at 10 years. Ventricular tachycardia burden was si gnificantly reduced after one procedure (23 vs. 11 VT episodes/year,P  
Source: Europace - December 24, 2016 Category: Cardiology Source Type: research

Elucidation of hidden slow conduction by double ventricular extrastimuli: a method for further arrhythmic substrate identification in ventricular tachycardia ablation procedures
This study analyses whether the response to a double ventricular extrastimulus during substrate mapping could identify slow conducting areas that are hidden during sinus rhythm.Methods and resultsConsecutive patients (n = 37) undergoing VTSA were prospectively included. Bipolar EGMs with>3 deflections and duration
Source: Europace - December 24, 2016 Category: Cardiology Source Type: research

Catheter ablation of atrial fibrillation in very young adults: a 5-year follow-up study
ConclusionIn the majority of very young adults catheter ablation for AF is effective, and associated with an acceptable complication rate. SHD and obesity are predictors for AF recurrence in this population. (Source: Europace)
Source: Europace - December 24, 2016 Category: Cardiology Source Type: research

Single lead atrial vs. dual chamber pacing in sick sinus syndrome: extended register-based follow-up in the DANPACE trial
ConclusionThis register-based long-term follow-up study indicates that there is no difference in mortality among patients with SSS randomized to AAIR or DDDR pacing, even with very long follow-up. Nor is there any difference in risk of AF hospitalization, stroke or HF. The higher rate of pacing mode-change to DDDR in the AAIR group suggests a different management of patients with an AAIR PM after the DANPACE trial. (Source: Europace)
Source: Europace - December 24, 2016 Category: Cardiology Source Type: research

Neural networks as a tool to predict syncope risk in the Emergency Department
ConclusionThe results of our study suggest that ANNs are effective in predicting the short-term risk of patients with syncope. Prospective studies are needed in order to compare ANNs ’ predictive capability with existing rules and clinical judgment. (Source: Europace)
Source: Europace - December 24, 2016 Category: Cardiology Source Type: research

Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation
AbstractAimsLeft atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF (PAF) and severe LA scarring identified by 3D mapping, undergoing pulmonary vein isolation (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI+ ablation of the non-PV triggers.Methods and resultsTotally, 177 consecutive patients with PAF and severe LA scarring were included. Patients underwent PVAI only (n = 45, Group 1), PVAI+ sca...
Source: Europace - December 24, 2016 Category: Cardiology Source Type: research

Association between sleep disordered breathing and electrocardiographic markers of atrial abnormalities: the MESA study
AbstractAimsElectrocardiographic (ECG) markers of left atrial (LA) abnormalities have been linked to increased risk of atrial fibrillation (AF). Sleep disordered breathing (SDB) has been associated with increased risk of AF. We aimed to examine the association of ECG markers of LA abnormalities with SDB.Methods and results1546 participants (mean age 67.2 years, 53.4% women, and 63.3% non-whites) from the Multi-Ethnic Study of Atherosclerosis Exam 5 Sleep ancillary study were included in this analysis. ECG markers of LA abnormalities (P wave terminal force in V1 (PTFV1), maximum P wave duration, PR interval and heart rate ...
Source: Europace - December 24, 2016 Category: Cardiology Source Type: research

The Italian subcutaneous implantable cardioverter-defibrillator survey: S-ICD, why not?
ConclusionThe vast majority of patients needing ICD therapy are suitable candidates for S-ICD implantation. Nevertheless, it currently seems to be preferentially adopted for secondary prevention of sudden death in young patients with channelopathies. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Eighth TRM Forum on Computer Simulation and Experimental Assessment of Cardiac Function: Towards Integration of Cardiac Functions
(Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

New insights from a computational model on the relation between pacing site and CRT response
ConclusionsIn these model simulations, the best cardiac function was obtained when pacing the mid-basal LV lateral wall, because of fastest recruitment of LV activation. This study illustrates how computer modeling can shed new light on optimizing pacing therapies for CRT. The results from this study may help to design new clinical studies to further investigate the importance of the pacing site for CRT response. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Comparing maximum rate and sustainability of pacing by mechanical vs. electrical stimulation in the Langendorff-perfused rabbit heart
ConclusionIn this study, we demonstrate that the maximum pacing rate at which MS can be sustained is lower than that for same-site ES in isolated heart, and that, in contrast to ES, the sustainability of successful 1:1 capture by MS is limited. The mechanism(s) of differences in MS vs. ES pacing ability, potentially important for emergency heart rhythm management, are currently unknown, thus warranting further investigation. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Impact of mechanical deformation on pseudo-ECG: a simulation study
ConclusionsTissue deformation has to be taken into account when estimating the S- and T-wave of the ECG in electrophysiological simulations. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Human-induced pluripotent stem cell-derived cardiomyocytes from cardiac progenitor cells: effects of selective ion channel blockade
ConclusionIn hiPSC‐derived cardiomyocytes of cardiac origin, INa, ICaL, IKr, and IKs were present as tetrodotoxin-, nifedipine-, E4031-, and JNJ303-sensitive currents, respectively. Although cardiac differentiation efficiency was improved in hiPSCs of cardiac vs. non-cardiac origin, no major functional differences were observed between hiPSC‐derived cardiomyocytes of different somatic cell origins. Further studies are warranted to characterize electrophysiological properties of hiPSC‐derived cardiomyocytes generated from CPCs. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

A feasibility study of arrhythmia risk prediction in patients with myocardial infarction and preserved ejection fraction
ConclusionsResults demonstrate that the personalized virtual heart simulation approach may provide a novel risk stratification modality to non-invasively and effectively identify patients with LVEF >35% who could benefit from ICD implantation. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Atrial fibrillation septal pacing: translation of modelling results
ConclusionChanges in AF substrate significantly impacted septal pacing outcomes and response to rapid AF pacing may similarly vary patient-to-patient. The number of stimulation electrodes had a lesser impact, suggesting that the design of a ring with 3–4 electrodes around the septum would be sufficient for most AF dynamics. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Electrical remodelling in patients with iatrogenic left bundle branch block
ConclusionThis study in patients with TAVI-induced LBBB shows that repolarization changes develop within months after onset of LBBB, and that these changes are highly variable between individual patients. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Human ventricular activation sequence and the simulation of the electrocardiographic QRS complex and its variability in healthy and intraventricular block conditions
ConclusionVariability in activation sequence and passive conduction properties captures and explains a large part of the clinical variability observed in the human QRS complex. Our physiological insights allow for a deeper interpretation of human QRS biomarkers in terms of QRS morphology and location of early endocardial activation sites. This might be used to attain a better patient-specific knowledge of activation sequence from routine body-surface electrocardiograms. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Influence of the earliest right atrial activation site and its proximity to interatrial connections on P-wave morphology
ConclusionThe electrical contributor’s site of earliest activation and intactness of posterior IACs affect PTF-V1 significantly by changing LA breakthrough sites independent from LA size. This should be considered for interpretation of electrocardiographical signs of LA abnormality and LA enlargement. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Changes in P-wave morphology after pulmonary vein isolation: insights from computer simulations
ConclusionPV isolation and reconnection induced measurable changes on the 16-lead ECG that might be used to improve patient follow-up after ablation. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

The Visible Heart ® project and free-access website ‘Atlas of Human Cardiac Anatomy’
ConclusionVisible Heart® methodologies have enabled our laboratory to reanimate 75 human hearts and visualize functional cardiac anatomies and device/tissue interfaces. The website freely shares all images, video clips and CT/MRI DICOM files in honour of the generous gifts received from donors and their families. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Localization of premature ventricular contractions from the papillary muscles using the standard 12-lead electrocardiogram: a feasibility study using a novel cardiac isochrone positioning system
ConclusionA simplified form of ECGi utilizing only 12 standard electrocardiographic leads may facilitate accurate localization of the origin of papillary muscle PVCs. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Histological evidence of inflammatory reaction associated with fibrosis in the atrial and ventricular walls in a case–control study of patients with history of atrial fibrillation
AimsChronic inflammation in the atrial myocardium was shown to play an important role in the development of atrial fibrosis in patients with atrial fibrillation (AF). However, it is not clear to what extent atrial inflammatory reaction associated with AF extends on the ventricular myocardium. Our aim was to assess the extent of fibrosis and lymphomononuclear infiltration in human ventricular myocardium and explore its association with AF.Methods and resultsMedical records from consecutive autopsies were checked for presence of AF. Heart specimens from 30 patients died from cardiovascular causes (64 ± 1...
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Modelling methodology of atrial fibrosis affects rotor dynamics and electrograms
ConclusionThe specific representation of fibrosis has a large effect on rotor dynamics and needs to be carefully considered for patient specific modelling. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Towards personalized computational modelling of the fibrotic substrate for atrial arrhythmia
Atrial arrhythmias involving a fibrotic substrate are an important cause of morbidity and mortality. In many cases, effective treatment of such rhythm disorders is severely hindered by a lack of mechanistic understanding relating features of fibrotic remodelling to dynamics of re-entrant arrhythmia. With the advent of clinical imaging modalities capable of resolving the unique fibrosis spatial pattern present in the atria of each individual patient, a promising new research trajectory has emerged in which personalized computational models are used to analyse mechanistic underpinnings of arrhythmia dynamics based on the dis...
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Cardiac MRI Anatomy and Function as a Substrate for Arrhythmias
The use of cardiovascular magnetic resonance (CMR) has been implemented in the diagnostic work-up of patients with cardiomyopathies by providing an accurate assessment of biventricular volumes and function and a detailed myocardial tissue characterization in a one-stop-shop multi-parametric imaging technique. Its unique capability to perform an accurate tissue characterization of the myocardium, which is superior to other imaging modalities, has prompt its use in the analysis of myocardial arrhythmic substrates and in the prognostic risk stratification of patients. Although left ventricular ejection fraction (LVEF) has alw...
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Patient-specific modeling of left ventricular electromechanics as a driver for haemodynamic analysis
ConclusionUsing the developed modeling workflow, the use of EM LV models as driver of fluid flow simulations is becoming feasible. While EM models are costly to construct, they constitute an important and nontrivial step towards fully coupled electro-mechano-fluidic (EMF) models and show promise as a tool for predicting the response to interventions which affect afterload conditions. (Source: Europace)
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Analysis of lead placement optimization metrics in cardiac resynchronization therapy with computational modelling
AimsThe efficacy of cardiac resynchronization therapy (CRT) is known to vary considerably with pacing location, however the most effective set of metrics by which to select the optimal pacing site is not yet well understood. Computational modelling offers a powerful methodology to comprehensively test the effect of pacing location in silico and investigate how to best optimize therapy using clinically available metrics for the individual patient.Methods and resultsPersonalized computational models of cardiac electromechanics were used to perform an in silico left ventricle (LV) pacing site optimization study as part of biv...
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Non-invasive, model-based measures of ventricular electrical dyssynchrony for predicting CRT outcomes
AimsLeft ventricular activation delay due to left bundle branch block (LBBB) is an important determinant of the severity of dyssynchronous heart failure (DHF). We investigated whether patient-specific computational models constructed from non-invasive measurements can provide measures of baseline dyssynchrony and its reduction after CRT that may explain the degree of long-term reverse ventricular remodelling.Methods and resultsLV end-systolic volume reduction (ΔESVLV) measured by 2D trans-thoracic echocardiography in eight patients following 6 months of CRT was significantly (P 
Source: Europace - December 23, 2016 Category: Cardiology Source Type: research

Left atrial anatomy, atrial fibrillation burden, and P-wave duration —relationships and predictors for single-procedure success after pulmonary vein isolation
ConclusionsIn our cohort of patients with symptomatic AF, the AFB and the P-wave duration but none of the anatomical parameter revealed to be independent predictors for AF/AT recurrence after circumferential antral pulmonary vein isolation. (Source: Europace)
Source: Europace - December 22, 2016 Category: Cardiology Source Type: research

Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis
ConclusionOur findings suggest that patients who develop pacing-induced cardiomyopathy and are upgraded to CRT may not derive any significant benefit from the addition of the defibrillator in the absence of a history of ventricular arrhythmias. (Source: Europace)
Source: Europace - December 22, 2016 Category: Cardiology Source Type: research

Intermuscular technique for implantation of the subcutaneous implantable cardioverter defibrillator: long-term performance and complications
ConclusionOur intermuscular technique and implant methodology is successful for placement of the subcutaneous defibrillator pulse generator. Our technique leads to an excellent cosmetic result and high levels of patient satisfaction. Rates of first shock conversion during defibrillation testing, inappropriate shocks, and complications during follow-up compare favourably with previous published case series. There were no left arm movement limitations post-operatively. (Source: Europace)
Source: Europace - December 22, 2016 Category: Cardiology Source Type: research

The increased risk of stroke/transient ischemic attack in women with a cardiac implantable electronic device is not associated with a higher atrial fibrillation burden
AbstractAimsTo evaluate if the increased thromboembolic risk in female patients may be related to a higher burden of atrial fibrillation (AF).Methods and resultsData collected in a prospective observational research of patients implanted with a cardiac implantable electrical device (CIED) were analysed. We included 2398 patients: 489 (20.4%) were female and 1909 (79.6%) were male (oral anticoagulants treatment in 23.2%, independent of gender). During the follow-up (mean 42.8, median 37.7 months), 26 thromboembolic events occurred in 22 patients, with an incidence rate ratio of both stroke and stroke/transient ischemic att...
Source: Europace - December 22, 2016 Category: Cardiology Source Type: research

Multicentre safety of adding Focal Impulse and Rotor Modulation (FIRM) to conventional ablation for atrial fibrillation
AimsFocal Impulse and Rotor Modulation (FIRM) uses 64-electrode basket catheters to identify atrial fibrillation (AF)-sustaining sites for ablation, with promising results in many studies. Accordingly, new basket designs are being tested by several groups. We set out to determine the procedural safety of adding basket mapping and map-guided ablation to conventional pulmonary vein isolation (PVI).Methods and resultsWe collected 30  day procedural safety data in five US centres for consecutive patients undergoing FIRM plus PVI (FIRM-PVI) compared with contemporaneous controls undergoing PVI without FIRM. A total of 62...
Source: Europace - December 22, 2016 Category: Cardiology Source Type: research

Novel electrocardiographic dyssynchrony criteria improve patient selection for cardiac resynchronization therapy
AbstractAimsWe hypothesized that the greater the intra- or interventricular dyssynchrony (intraD, interD), the more effective cardiac resynchronization therapy (CRT) is. We sought to improve patient selection for CRT by using novel ECG dyssynchrony criteria.Methods and resultsLeft ventricular (LV) intraD was estimated by the absolute time difference between the intrinsicoid deflections (ID) in leads aVL and aVF divided by the QRS duration (QRSd): [aVLID − aVFID]/QRSd (%). InterD was estimated from the formula: [V5ID  − V1ID]/QRSd (%). Their  >25% value indicated electrical dyssynchrony p...
Source: Europace - December 20, 2016 Category: Cardiology Source Type: research

Defibrillation thresholds with right pectoral implantable cardioverter defibrillators and impact of waveform tuning (the Tilt and Tune trial)
ConclusionThis first randomized trial investigating DFTs with right ICDs confirms relatively higher DFTs with RICDs than reported for left pectoral ICDs. However, DFTs were generally unaffected by 3.5 ms time constant-based waveform tuning compared with a 50% tilt waveform. Implant testing may be preferred with RICDs.Clinical trial numberNCT00873691. (Source: Europace)
Source: Europace - December 16, 2016 Category: Cardiology Source Type: research

Mapping and ablation of anteroseptal atrial tachycardia in patients with congenitally corrected transposition of the great arteries: implication of pulmonary sinus cusps
ConclusionAnteroseptal AT in patients with ccTGA could be eliminated by ablation inside the PSC. (Source: Europace)
Source: Europace - December 13, 2016 Category: Cardiology Source Type: research

Management of functional Sprint Fidelis leads at cardiac resynchronization therapy-defibrillator generator replacement: a novel option for preventing inappropriate shocks from lead failure in fragile patients with high risk of sudden death †
ConclusionsIn CRT-D patients with a functional Fidelis lead and a bipolar LV lead, switching of the Fidelis lead pace/sense IS-1 pin with the bipolar LV lead IS-1 pin at generator replacement did not affect normal system function. This novel approach may be valuable in fragile patients with high risk of sudden death for prevention of inappropriate shocks triggered by oversensing from a malfunctioning Fidelis lead. (Source: Europace)
Source: Europace - December 9, 2016 Category: Cardiology Source Type: research

Adverse outcomes in patients with atrial fibrillation and peripheral arterial disease: a report from the EURObservational research programme pilot survey on atrial fibrillation
AbstractAimsPeripheral arterial disease (PAD) is highly prevalent in general population. Data on the prevalence of symptomatic PAD in patients with atrial fibrillation (AF) are limited, and the impact of PAD on adverse outcomes in AF patients is controversial. Our aims were: (i) to define the prevalence of symptomatic PAD in European AF patients and describe its associated clinical risk factors and (ii) to establish the relationship of PAD to adverse events in AF, especially all-cause death.Methods and resultsAtrial fibrillation patients enrolled in the EORP-AF Pilot study with data about PAD status were included in this a...
Source: Europace - December 9, 2016 Category: Cardiology Source Type: research

Important reduction of the radiation dose for pulmonary vein isolation using a multimodal approach
AbstractAimsThe number of pulmonary vein isolation (PVI) ablation procedures is steadily increasing worldwide resulting in a substantial radiation exposure to patients and operators. The aim of our study was to reduce radiation exposure during these procedures to a critical amount without compromising patient safety.Methods and resultsFirst, we assessed radiation exposure for primary PVI procedures over time (2005 –2015) at the University Heart Center Freiburg-Bad Krozingen. Second, we prospectively evaluated in 52 patients, the efficacy and safety of a novel radiation reduction program (particularly applying an enha...
Source: Europace - December 7, 2016 Category: Cardiology Source Type: research

Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy
AbstractAimsA dilated/end-stage phase of hypertrophic cardiomyopathy (HCM) is rare but well-recognized. The role for cardiac resynchronization therapy (CRT) in this subset of patients remains unexplored. We aimed to clarify the impact of bi-ventricular pacing CRT in dilated/end-stage HCM.Methods and resultsThe Mayo Clinic HCM database was interrogated to identify patients with ejection fraction (EF)  
Source: Europace - December 7, 2016 Category: Cardiology Source Type: research

Higher burden of supraventricular ectopic complexes early after catheter ablation for atrial fibrillation is associated with increased risk of recurrent atrial fibrillation
AbstractAimsEarly identification of patients who could benefit from early re-intervention after catheter ablation is highly warranted. Our aim was to investigate the association between post-procedural burden of supraventricular ectopic complexes (SVEC) and the risk of long-term atrial fibrillation (AF) recurrence.Methods and resultsA total of 125 patients undergoing catheter ablation for AF were included. Patients underwent 7-day Holter recordings immediately post-procedural. The number of SVEC in post-procedural Holter recordings was categorized into quartiles: 0 –72, 73–212, 213–782 and ≥&thi...
Source: Europace - December 7, 2016 Category: Cardiology Source Type: research

Reappraisal and new observations on atrial tachycardia ablated from the non-coronary aortic sinus of Valsalva
ConclusionsAT ablated from the NCS is a paroxysmal arrhythmia in middle-aged women, with distinct electrocardiographic and electrophysiological characteristics. We suspect the retroaortic node to be involved in the tachycardia circuit. (Source: Europace)
Source: Europace - December 7, 2016 Category: Cardiology Source Type: research

Cardiac resynchronization therapy (CRT) device replacement considerations: upgrade or downgrade? A complex decision in the current clinical setting
There are limited data about the management of patients presenting for elective generator replacements in the setting of previously implanted cardiac resynchronization therapy (CRT) devices that are nearing end-of-life. The individual patient ’s clinical status and concomitant morbidities may evolve so that considerations may include not only replacement of the pulse generator, but also potentially changing the type of device [e.g. downgrading CRT-defibrillator (CRT-D) to CRT-pacemaker (CRT-P) or ICD or upgrading of CRT-P to CRT-D]. Mo reover, the clinical evidence for CRT-D/CRT-P implantation may change over time, w...
Source: Europace - December 5, 2016 Category: Cardiology Source Type: research