Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes
ConclusionsLeft atrial symmetry changes are associated with DD and dilatation. Since DD could cause LA remodelling, appropriate early treatment should be considered for AF patients with DD, before geometrical changes occur. (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Cardiac arrhythmias in patients with Danon disease
ConclusionsThe present study indicates that the distinct surface ECG pattern in Danon disease is not associated with ventricular pre-excitation. Atrial fibrillation is frequently observed in these patients and may be associated with thromboembolic events in the young, while sustained ventricular arrhythmias occur less frequently than previously reported. (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Validation of defibrillator lead performance registry data: insight from the Danish Pacemaker and ICD Register
ConclusionThe validity of data on defibrillator lead performance recorded in the DPIR is excellent for the specific types of lead intervention and good for the specific reasons for defibrillator lead intervention. The validity of the less detailed overall reasons for lead interventions commonly used to report lead performance is also excellent. These findings indicate high registry data quality appropriate for scientific analysis and industry-independent post-marketing surveillance. (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Prognostic impact of chronic total coronary occlusion on long-term outcomes in implantable cardioverter-defibrillator recipients with ischaemic heart disease
AbstractAimsThe prognostic impact of chronic total coronary occlusion (CTO) on implantable cardioverter-defibrillator (ICD) recipients remains unclear.Methods and resultsEighty-four consecutive patients with ischaemic heart disease who received ICD therapy for primary or secondary prevention were analysed. We investigated all-cause mortality and major adverse cardiac events (MACEs) including cardiac death, appropriate device therapy, hospitalization for heart failure, and ventricular assist device implantation. Of the study patients (mean age 70 ± 8 years; 86% men), 34 (40%) had CTO. There were no significant differ...
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Cryoballoon ablation of persistent atrial fibrillation: feasibility and safety of left atrial roof ablation with generation of conduction block in addition to antral pulmonary vein isolation
ConclusionGeneration of linear roofline lesions is possible with the second-generation cryoballoon. The technique can be used in combination with PV isolation to treat persistent AF with good acute success rates, short procedure times, and acceptable safety concerns. If validated by further studies, the method would be an appealing alternative to radiofrequency ablation techniques. (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Cryoablation of atrioventricular nodal re-entrant tachycardia: 7-year follow-up in 515 patients —confirmed safety but very late recurrences occur
ConclusionCryoablation in AVNRT is safe with a long-term efficacy of 88%; however, very late recurrences occur. (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Should all-comers with atrioventricular nodal re-entrant tachycardia or selected patients only be treated with cryoablation?
This editorial refers to ‘Cryoablation of atrioventricular nodal re-entrant tachycardia: 7-year follow-up in 515 patients—confirmed safety but very late recurrences occur’ by P. Insulander et al., on pages 1038–1042 (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Death and thrombo-embolic risk after ablation of atrial flutter compared with atrial fibrillation: a nationwide cohort study
ConclusionIn this observational study, patients with atrial flutter had a significantly higher all-cause mortality rate compared with those with AF after an ablation procedure, but similar thrombo-embolic event rates. Future studies should elucidate the reason for this difference in mortality. (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Safety of magnetic resonance scanning without monitoring of patients with pacemakers
ConclusionIt is possible to perform MRI scans relatively safely in PM patients without additional monitoring or change in the normal MRI protocol, given that the PM has been assessed and reprogrammed prior to MRI. This is especially important to remember in the acute setting where MRI scans may be delayed when monitoring facilities are unavailable. (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Safety, long-term outcomes and predictors of recurrence after first-line combined endoepicardial ventricular tachycardia substrate ablation in arrhythmogenic cardiomyopathy. Impact of arrhythmic substrate distribution pattern. A prospective multicentre study
This study reports procedural safety, outcomes, and predictors of recurrence.Methods and ResultsForty-one consecutive patients [12 with left ventricle (LV) involvement, 7 left-dominant] underwent first-line endoepicardial VT substrate ablation. Standard bipolar and unipolar thresholds were used to define low-voltage areas (LVA). Arrhythmogenic substrate area (ASA) was defined as the area containing electrograms with delayed components. Implantable cardioverter defibrillator interrogations were evaluated for VT recurrence. Epicardial LVA was larger in all cases (102.5 ± 78.6 vs. 19.3 ± 24.4 cm2;P0.23 predicted...
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Role of adenosine-guided pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a meta-analysis
ConclusionFrom the available data of clinical studies, adenosine-guided PVI was associated with an increased arrhythmia-free survival when compared with conventional PVI in patients undergoing catheter ablation for AF. (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Rationale and design of AXAFA-AFNET 5: an investigator-initiated, randomized, open, blinded outcome assessment, multi-centre trial to comparing continuous apixaban to vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation
ConclusionThe results of AXAFA-AFNET 5 will provide evidence informing about the safety of apixaban in ablation patients and on its efficacy including effects on silent brain lesions. AXAFA – AFNET 5 is an investigator-initiated trial sponsored by AFNET. The trial is supported by the DZHK (German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research) and by Bristol-Myers Squibb/Pfizer Alliance. (Source: Europace)
Source: Europace - October 14, 2016 Category: Cardiology Source Type: research

Brugada syndrome in the young: an assessment of risk factors predicting future events
ConclusionSymptomatic BS in the young age is a rare but malignant condition that can manifest with a spectrum of electrical abnormalities (i.e. SND, atrial tachycardias, AV block, and infra-nodal conduction delay) and result in the extreme cases in lethal arrhythmic events and SCD. (Source: Europace)
Source: Europace - October 13, 2016 Category: Cardiology Source Type: research

Lead extraction outcomes in patients with congenital heart disease
This study addresses the safety of extraction in patients with structural heart disease and previous cardiac surgery.Methods and resultsThis retrospective study included 40 CHD and 80 matched control patients, who underwent transvenous lead extractions between 2001 and 2014. Only leads>12 months were included. There were 77 leads in CHD patients and 146 in controls. The mean age was 38 ± 16 years in CHD patients. Ninety per cent of CHD patients had ≥1 cardiac surgeries when compared with 21% of controls (P
Source: Europace - October 13, 2016 Category: Cardiology Source Type: research

The vortex of three-dimensional mapping with a centrifugal ventricular assist device
(Source: Europace)
Source: Europace - October 12, 2016 Category: Cardiology Source Type: research

Successful radiofrequency catheter ablation for ventricular tachycardia of a 2.9 kg infant with Ebstein's anomaly
(Source: Europace)
Source: Europace - October 12, 2016 Category: Cardiology Source Type: research

Cost-effectiveness of screening for atrial fibrillation in primary care with a handheld, single-lead electrocardiogram device in the Netherlands
ConclusionScreening for AF in primary care with a handheld, single-lead ECG during seasonal influenza vaccination is very likely to be cost saving for identifying new cases of AF in the Dutch population aged 65 years and over. Active screening for AF with a single-lead, handheld ECG device during seasonal influenza vaccination could be implemented in primary care. (Source: Europace)
Source: Europace - October 11, 2016 Category: Cardiology Source Type: research

Complete tear-off of a Riata dual coil lead tip
We report the case of a young woman who incidentally presented with a complete tear-off of the tip of a Riata dual coil lead while the device had reached ERI criteria. Years ago, an additional pace/sense electrode had been added due to an exit block defibrillation functioning properly. Although defibrillation properties were still adequate at the time of generator exchange, we decided to revise the lead surgically. (Source: Europace)
Source: Europace - October 11, 2016 Category: Cardiology Source Type: research

Peri-mitral atrial tachycardia mimicking localized reentry after the superior transseptal approach
(Source: Europace)
Source: Europace - October 11, 2016 Category: Cardiology Source Type: research

Venous access and long-term pacemaker lead failure: comparing contrast-guided axillary vein puncture with subclavian puncture and cephalic cutdown
AbstractAimsExisting data on the relationship between venous access and long-term pacemaker lead failure (PLF) are scarce and inconsistent. We aim to study the hypothesis that contrast-guided axillary vein puncture (AP) is better than subclavian puncture (SP) and similar to cephalic vein cutdown (CV) in the incidence of PLF and the success rate of AP is higher than CV.Methods and resultsThe case records of 409 patients with 681 implantable pacemaker leads were reviewed. Two hundred and fifty-two, 217, and 212 leads were implanted via AP, CV, and SP, respectively. With a mean follow-up of 73.6 ± 33.1 months, 20 (2.9%...
Source: Europace - October 11, 2016 Category: Cardiology Source Type: research

Migration of femoral vein thrombus to the right ventricle: an undesiderable complication in patients undergoing electrophysiological procedures
(Source: Europace)
Source: Europace - October 11, 2016 Category: Cardiology Source Type: research

‘Smart’ solutions for paroxysmal atrial fibrillation?
On the basis of the review of Carpenter and Frontera we present a case of a 66-year-old female patient who was implanted with an implantable loop recorder (ILR) (LinQ, Medtronic) due to a history of unexplained syncope and symptoms of palpitations. After the procedure, the patient received a smartwatch device (E4, Empatica), which measures the photoplethysmography (PPG) signal at the wrist, and an iPhone 5S smartphone with a custom-made application (FibriCheck®), which measures the PPG signal in the tip of the finger using the smartphone camera. (Source: Europace)
Source: Europace - October 11, 2016 Category: Cardiology Source Type: research

Data mining experiments on the Angiotensin II-Antagonist in Paroxysmal Atrial Fibrillation (ANTIPAF-AFNET 2) trial: ‘exposing the invisible’
ConclusionsWith the ANTIPAF-AFNET 2 dataset, the present data-mining analyses suggest that a baseline SF-12 mental component score, age, systolic blood pressure, BUN, and creatinine level of the patients are predictors of AF burden. Additional studies are necessary to understand the distinct kidney-specific pathophysiological pathways that contribute to AF burden. (Source: Europace)
Source: Europace - October 11, 2016 Category: Cardiology Source Type: research

Catheter ablation for atrial fibrillation in a patient with unilateral left pulmonary artery agenesis: an enlarged right pulmonary vein caused arrhythmogenicity of atrial fibrillation
(Source: Europace)
Source: Europace - October 11, 2016 Category: Cardiology Source Type: research

Prosthesis depth and conduction disturbances after last generation balloon-expandable transcatheter aortic valve implantation
ConclusionsA low AVR is associated to higher ΔPR and PPMI rates. The correlation between LVOT prosthesis depth with ΔPR and higher PPMI rate suggests the need of a careful S3-THV implantation. (Source: Europace)
Source: Europace - October 6, 2016 Category: Cardiology Source Type: research

Frequency of different electrocardiographic abnormalities in a large cohort of Spanish workers
ConclusionThis study shows the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. The frequencies of many ECG patterns related to an adverse prognosis (left ventricular hypertrophy, complete left bundle branch block, T wave abnormalities, ST segment abnormalities, and atrial fibrillation) were low. (Source: Europace)
Source: Europace - October 6, 2016 Category: Cardiology Source Type: research

Association of cardiac resynchronization therapy with the incidence of appropriate implantable cardiac defibrillator therapies in ischaemic and non-ischaemic cardiomyopathy
ConclusionsThese data suggest that CRT is associated with significantly lower rates of first AICDT use in NIDC patients, but not in ischaemic patients. This study suggests that ICD patients with NIDC and left bundle branch block experiencing VAs may benefit from an upgrade to CRT-ICD despite being in a good functional class. (Source: Europace)
Source: Europace - October 6, 2016 Category: Cardiology Source Type: research

Rationale and design of the BUDAPEST-CRT Upgrade Study: a prospective, randomized, multicentre clinical trial
ConclusionThe results of our prospective, randomized, multicentre clinical trial will provide important information on the role of cardiac resynchronization therapy with defibrillator (CRT-D) upgrade in patients with symptomatic HF, reduced LVEF, and wide-paced QRS with intermittent or permanent RV pacing.Clinical trials.gov identifierNCT02270840. (Source: Europace)
Source: Europace - October 6, 2016 Category: Cardiology Source Type: research

Safe automatic one-lead electrocardiogram analysis in screening for atrial fibrillation
ConclusionAutomatic ECG screening using a computerized algorithm safely identifies normal ECGs in Lead I and reduces the need for manual evaluation of individual ECGs with>85% with 100% sensitivity on an individual basis. (Source: Europace)
Source: Europace - October 6, 2016 Category: Cardiology Source Type: research

Left univentricular pacing for cardiac resynchronization therapy
AbstractThis review describes the rationale and published evidence for left univentricular pacing for cardiac resynchronization therapy, gives an overview of the existing optimization algorithms featuring this mode, and discusses future perspectives. (Source: Europace)
Source: Europace - October 6, 2016 Category: Cardiology Source Type: research

The clinical value of T-wave alternans derived from Holter monitoring
Microvolt-level T-wave alternans (TWA) assessed by spectral method during an exercise stress test has been widely studied for risk stratification. Several studies have documented the association of a positive TWA with total mortality and arrhythmic events. Nevertheless, the need to achieve an elevated and stabilized heart rate resulting in a considerable proportion of indeterminate test results constitutes one of the main limitations of this method. It is well recognized that arrhythmic events may be triggered not only by physical but also by mental stress and are not necessarily associated with exercise. Detection of TWA ...
Source: Europace - October 6, 2016 Category: Cardiology Source Type: research

Emerging molecular therapies targeting myocardial infarction-related arrhythmias
Cardiac disease is the leading cause of death in the developed world. Ventricular arrhythmias associated with myocardial ischaemia and/or infarction are a major contributor to cardiovascular mortality, and require improved prevention and treatment. Drugs, devices, and radiofrequency catheter ablation have made important inroads, but have significant limitations ranging from incomplete success to undesired toxicities and major side effects. These limitations derive from the nature of the intervention. Drugs are frequently ineffective, target the entire heart, and often do not deal with the specific arrhythmia trigger or sub...
Source: Europace - October 6, 2016 Category: Cardiology Source Type: research

Functional improvement after successful catheter ablation for long-standing persistent atrial fibrillation
AbstractAimsIdentifying patients who benefit from restored sinus rhythm (SR) would optimize the selection of candidates for ablation of long-standing persistent atrial fibrillation (LSPAF). This prospective study sought to identify the hitherto unknown factors associated with global functional improvement after successful radiofrequency catheter ablation of LSPAF.Methods and resultsIn 171 LSPAF patients (84% of the total consecutive 203 patients) who were examined in SR 12 months after ablation, the individual per cent change from baseline value in maximum oxygen consumption at exercise test (VO2 max), left ventricular eje...
Source: Europace - October 5, 2016 Category: Cardiology Source Type: research

Outcomes of lead extraction without subsequent device reimplantation
AbstractAimsOutcomes among patients who do not receive device reimplantation after cardiovascular implantable electronic device (CIED) extraction have not been well studied. The present study aims to investigate the outcomes of patients without device reimplantation after lead extraction and device removal.Methods and resultsWe retrospectively searched for consecutive patients who underwent CIED extraction at Mayo Clinic, Rochester, MN and University of California San Diego Medical Center from 2001 through 2012. Among the patients identified, we compared characteristics of those who did and did not have device reimplantati...
Source: Europace - October 5, 2016 Category: Cardiology Source Type: research

Improved patient selection for cardiac resynchronization therapy by normalization of QRS duration to left ventricular dimension
This study evaluates the relative importance of two components of QRS prolongation, myocardial conduction velocity and travel distance of the electrical wave front (i.e. path length), for the prediction of acute response to cardiac resynchronization therapy (CRT) in left bundle branch block (LBBB) patients.Methods and resultsThirty-two CRT candidates (ejection fraction
Source: Europace - October 5, 2016 Category: Cardiology Source Type: research

(T peak − T end )/QRS and (T peak − T end )/(QT × QRS): novel markers for predicting arrhythmic risk in the Brugada syndrome
(Source: Europace)
Source: Europace - October 5, 2016 Category: Cardiology Source Type: research

Frequent atrial extrasystolic beats predict atrial fibrillation in patients with congenital heart defects
This study therefore examined the predictive ability of atrial extrasystole (AES) for development of AF in CHD patients.Methods and resultsAdult CHD patients who had a 24 h Holter registration were followed to determine who developed AF. A total of 573 patients (49% male, mean age 35 ± 12 years) were included; they had a simple/complete repaired CHD (n = 279), complex repaired CHD (n = 251), or univentricular heart (UVH,n = 43). Ageing (P
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Patterns of physical activity and survival following cardiac resynchronization therapy implantation: the ALTITUDE activity study
AbstractAimsCardiac resynchronization therapy with implantable defibrillator backup (CRT-D) improves outcomes, but predictors and markers of response remain limited. Physical activity information collected by CRT devices may provide insights to CRT response and the relationship between activity changes and survival.Methods and resultsPatients entered into the LATITUDE remote monitoring system from 2008 to 2012 after receipt of a new CRT-D were eligible. Mean daily activity was calculated from LATITUDE uploads at baseline (first 3 –10 days following implant) and 6 months (180–210 days). Pairwise differences for ...
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Left atrial model reconstruction in atrial fibrillation ablation: reliability of new mapping and complex impedance systems
ConclusionsRecent 3D mapping tools allow outstanding anatomical rendering and are key in complex ablation procedure set-up. This study shows that 3D anatomical reconstruction of LA, PVs, and their variable branches is not only safe and fast but also accurate and reliable. (Source: Europace)
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Electrophysiological features and catheter ablation of symptomatic frequent premature atrial contractions
This study aimed to explore the electrophysiological features of PACs with and without inducing AF and to evaluate the effectiveness of catheter ablation for PACs.Methods and resultsThirty-five consecutive patients with symptomatic, frequent, and drug-refractory PACs in the absence of AF (group A) and 35 patients with PACs-induced AF (group B) were enrolled. Coupling intervals (CoIs) of PACs were compared. Premature atrial contractions were mapped by the point-by-point and/or circular mapping technique. Focal ablation or pulmonary vein/superior vena cava isolation was applied as appropriate. A total of 35 ectopic foci were...
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Contemporary rates and outcomes of single- vs. dual-coil implantable cardioverter defibrillator lead implantation: data from the Israeli ICD Registry
ConclusionReal-life rates of single-coil lead implantation are rising while adding no additional risk. These results of single-coil safety are reassuring and obtained, despite low and contemporary rates of DFT testing. (Source: Europace)
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

The slope of the initial temperature drop predicts acute pulmonary vein isolation using the second-generation cryoballoon
AbstractAimsThere is no objective, early indicator of occlusion quality, and efficacy of cryoballoon pulmonary vein isolation. As previous experience suggests that the initial cooling rate correlates with these parameters, we investigated the slope of the initial temperature drop as an objective measure.Methods and resultsA systematic evaluation of 523 cryoapplications in 105 patients using a serial ROC-AUC analysis was performed. We found the slope of a linear regression of the temperature –time function to be a good predictor (PPV 0.9, specificity 0.72, sensitivity 0.71, and ROC-AUC 0.75) of acute isolation. It als...
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Reduction of falls and fractures after permanent pacemaker implantation in elderly patients with sinus node dysfunction
AbstractAimsElderly patients with sinus node dysfunction (SND) are at increased risk of falls with possible injuries. However, the incidence of these adverse events and its reduction after permanent pacemaker (PPM) implantation are not known.Methods and resultsEighty-seven patients (mean [SD] age 75.4 [8.3] years, 51% women) with SND and an indication for cardiac pacing were included and were examined by a standardized interview targeting fall history. The incidence and total number of falls, falls with injury, falls requiring treatment, and falls resulting in a fracture were assessed for the time period of 12 months befor...
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Antiadrenergic autoimmunity in postural tachycardia syndrome
ConclusionThese data confirm a strong relationship between adrenergic autoantibodies and POTS. They support the concept that allosteric-mediated shifts in the α1AR and β1AR responsiveness are important in the pathophysiology of postural tachycardia. (Source: Europace)
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Time matters: adenosine testing immediately after pulmonary vein isolation does not substitute a waiting period
ConclusionAdenosine testing immediately after PVAI does not reliably exclude later spontaneous or adenosine-induced PV reconnection. Adenosine testing should be performed after an appropriate observation period to reduce risk of PV reconnection. (Source: Europace)
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Atrial fibrillation detection using a novel three-vector cardiac implantable monitor: the atrial fibrillation detect study
ConclusionContinuous monitoring using this novel device, equipped with a dedicated detection algorithm, yields an accurate and reliable detection of AF episodes. The ICM is a promising tool for tailoring individual AF patient management. Further long-term prospective studies are necessary to confirm these encouraging results. (Source: Europace)
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Traditional and novel electrocardiographic conduction and repolarization markers of sudden cardiac death
Sudden cardiac death, frequently due to ventricular arrhythmias, is a significant problem globally. Most affected individuals do not arrive at hospital in time for medical treatment. Therefore, there is an urgent need to identify the most-at-risk patients for insertion of prophylactic implantable cardioverter defibrillators. Clinical risk markers derived from electrocardiography are important for this purpose. They can be based on repolarization, including corrected QT (QTc) interval, QT dispersion (QTD), interval from the peak to the end of the T-wave (Tpeak– Tend), (Tpeak– Tend)/QT, T-wave alternans (TWA), an...
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Antiarrhythmic effect of vernakalant in an experimental model of Long-QT-syndrome
AimsThe antiarrhythmic drug vernakalant exerts antiarrhythmic effects in atrial fibrillation. Recent experimental data suggest interactions with the late sodium current and antiarrhythmic effects in ventricular arrhythmias. We aimed at investigating whether treatment with vernakalant reduces polymorphic ventricular tachycardia (VT) in an experimental model of Long-QT-syndrome (LQTS).Methods and resultsTwenty-nine isolated rabbit hearts were assigned to two groups and treated with erythromycin (300 µM,n = 15) or veratridine (0.5 µM,n = 14) after obtaining baseline data. Thereafter, vernakalant (10 µM) was ...
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Death after ablation of atrial flutter: are we doing the right thing?
This editorial refers to ‘Death and thrombo-embolic risk after ablation of atrial flutter compared with atrial fibrillation: a nationwide cohort study’ by H. Vadmannet al., doi:10.1093/europace/euw107. (Source: Europace)
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research

Time to implement fitness and reduction of fatness in atrial fibrillation therapy
This editorial refers to ‘Self-reported physical activity and major adverse events in patients with atrial fibrillation: a report from the EURObservational Research Programme Pilot Survey on Atrial Fibrillation (EORP-AF) General Registry’ by M. Proiettiet al., on pages 535 –543. (Source: Europace)
Source: Europace - October 4, 2016 Category: Cardiology Source Type: research