Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress
AbstractAimsAbnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise.Methods and resultsElectrocardiographical imaging (ECGI) reconstructs>1200 electrograms (EGMs) over the ventricles from a single beat, providing ep...
Source: Europace - February 28, 2019 Category: Cardiology Source Type: research

Ajmaline-induced Epsilon wave: as a potential interim risk factor between the spontaneous and drug-induced type 1 Brugada electrogram? — Authors’ reply
We really appreciate the interest shown by Araset al. in our article entitled ‘The prognostic impact of single extra-stimulus on programmed ventricular stimulation in Brugada patients without previous cardiac arrest: multi-centre study in Japan’. Management of asymptomatic Brugada individuals remains the most controversial issue. Recently, Moritaet al.1 stressed that the fragmented QRS is a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome (BrS), even in asymptomatic patients.2 In their letter,3 they propose the importance of drug-induced fragmented QRS for unmasking not only typ...
Source: Europace - June 8, 2018 Category: Cardiology Source Type: research

Ajmaline-induced epsilon wave: as a potential interim risk factor between the spontaneous- and drug-induced type 1 Brugada electrogram?
We read the two risk stratification articles in Brugada syndrome (BrS) patients with a great interest by Deliseet al.1 the article about the prognosis the prognosis is fairly good in patients with the BrS type 1 electrocardiogram (Br type 1 ECG) without prior sudden cardiac arrest (SCA) who do not undergo implantable cardioverter-defibrillator (ICD) implantation, and by the Takagiet al.2 about the stimulation protocol with a single extra-stimulus might be useful in stratifying risk in BrS patients with spontaneous type 1 ECG and syncope. We want to address some points that merit more attention. (Source: Europace)
Source: Europace - June 8, 2018 Category: Cardiology Source Type: research

In memoriam Dr Arthur J. Moss
The cardiology world has lost again one of its most esteemed and worldwide known scholar and experienced clinician. Dr Arthur J. Moss, born 21 June 1931, Professor of Medicine and Cardiology at Rochester University Medical Center (URMC), Rochester, NY passed away on 14 February 2018 at the age of 86. Knowing him, always being actively involved in many of the currently discussed electrophysiologic topics even to the last moments of his active scientific life, it is hard to comprehend that he is not any longer with us to advise and stimulate his colleagues and friends to promote modern medicine. (Source: Europace)
Source: Europace - May 28, 2018 Category: Cardiology Source Type: research

Peri-procedural routines, implantation techniques, and procedure-related complications in patients undergoing implantation of subcutaneous or transvenous automatic cardioverter-defibrillators: results of the European Snapshot Survey on S-ICD Implantation (ESSS-SICDI)
AbstractThe aim of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to assess peri-procedural practices, implantation techniques, and short-term procedure-related complications associated with implantation of subcutaneous implantable cardioverter-defibrillator (S-ICD) or transvenous implantable cardioverter-defibrillator (TV-ICD), across tertiary European electrophysiology centres. An internet-based electronic questionnaire concerning implantation settings, peri-procedural routines, techniques, personnel, complications, and patient outcomes was sent to the centres routinely implanting both TV-IC...
Source: Europace - May 11, 2018 Category: Cardiology Source Type: research

Comparison of robotic magnetic navigation-guided and manual catheter ablation of ventricular arrhythmias arising from the papillary muscles
ConclusionUse of an RMN-guided approach to target PM VAs results in comparable success rates seen with manual ablation but with lower fluoroscopy times and decreased use of transaortic retrograde access. (Source: Europace)
Source: Europace - May 1, 2018 Category: Cardiology Source Type: research

Oesophageal injury following magnetically guided single-catheter ablation for atrial fibrillation: insights from the MAGNA-AF registry
ConclusionMagnetically guided CA for AF with careful energy titration at the posterior LA wall and no oesophageal temperature monitoring is not associated with an increased incidence of oesophageal thermal injury. The routine use of periprocedural TOE may cause a low rate of mechanical oesophageal lesions but reliably prevents major complications like transient ischaemic attack, stroke, or cardiac tamponade. An observed high prevalence of upper digestive system inflammation (63%) may further support the recommendation for a routine post-interventional treatment with a proton-pump-inhibitor. (Source: Europace)
Source: Europace - May 1, 2018 Category: Cardiology Source Type: research

Long-term clinical outcomes of magnetically navigated rotor ablation as an adjunct to conventional pulmonary vein isolation
ConclusionAblation of rotors in combination with PVI using RMN was associated with a high success rate in this large cohort of consecutive patients. Significant proportion of patients exhibited RA rotors, which was associated with persistent AF, obstructive sleep apnoea, and obesity. (Source: Europace)
Source: Europace - May 1, 2018 Category: Cardiology Source Type: research

Catheter ablation of incisional atrial tachycardia using remote magnetic navigation in patients after heart surgery: comparison between acquired and congenital heart disease
ConclusionCatheter ablation of IAT in patients after heart surgery using RMN is safe and effective. No significant differences related to success rates and procedure characteristics were found between patients with AHD and CHD. (Source: Europace)
Source: Europace - May 1, 2018 Category: Cardiology Source Type: research

Clinical research: remote magnetic navigation vs. manually controlled catheter ablation of right ventricular outflow tract arrhythmias: a retrospective study
AbstractAimsRemote magnetic navigation (RMN) is an alternative to manual catheter control (MCC) radiofrequency ablation of right ventricular outflow tract (RVOT) arrhythmias. The data to support RMN approach is limited. We aimed to investigate the clinical and procedural outcomes in a cohort of patients undergoing RVOT premature ventricular complex/ventricular tachycardia (PVCs/VT) ablation procedures using RMN vs. MCC.Methods and resultsData was collected from two centres. Eighty-nine consecutive RVOT PVCs/VT ablation procedures were performed in 75 patients; RMN: 42 procedures and MCC: 47 procedures. CARTOXPTM or CARTO3 ...
Source: Europace - May 1, 2018 Category: Cardiology Source Type: research

Procedural and long-term outcome after catheter ablation of idiopathic outflow tract ventricular arrhythmias: comparing manual, contact force, and magnetic navigated ablation
AbstractAimsCurrently, comparative data on procedural and long-term clinical outcome of outflow tract (OT) idiopathic ventricular arrhythmia (IVA) ablation with manual (MAN), contact force (CF), and magnetic navigation system (MNS) ablation are lacking. The aim of this study was to compare the procedural and long-term clinical outcome of MAN, CF, and MNS ablation of OT IVAs.Methods and resultsSeventy-three patients (31 MAN, 17 CF, and 25 MNS patients; consecutive per group) with OT IVA, who underwent catheter ablation in our centre were analysed. Procedural success rates (success at the end of the procedure), procedural da...
Source: Europace - May 1, 2018 Category: Cardiology Source Type: research

Early and long-term outcomes after manual and remote magnetic navigation-guided catheter ablation for ventricular tachycardia
ConclusionRemote magnetic navigation may improve clinical outcomes after catheter ablation of VT in patients with ischaemic cardiomyopathy. Further prospective clinical studies are required to confirm these findings. (Source: Europace)
Source: Europace - May 1, 2018 Category: Cardiology Source Type: research

Contact force with magnetic-guided catheter ablation
AbstractAimsAchieving adequate catheter tip-tissue contact is essential for delivering robust radiofrequency (RF) ablation lesions. We measured the contact force generated by a remote magnetic-guided catheter navigation system.Methods and resultsA plexiglass model with an integrated scale was fashioned to mimic transvenous and retrograde access to sites in the right atrium and right and left ventricles. An 8  Fr RF ablation catheter was steered by remote magnetic guidance at fields of 0.08 and 0.10 T, with and without a long sheath positioned at the entrance of the chamber. Ten contact force readings were tak...
Source: Europace - May 1, 2018 Category: Cardiology Source Type: research

In Memoriam Luigi Padeletti: an Italian Scientist, an Italian Maestro, an Italian Friend
Professor Luigi Padeletti passed away, unexpectedly, on 15 December 2017 at the age of 70. He was born in Gubbio one of the most beautiful towns in Umbria, in the centre of Italy, and he always stayed closely in touch with his natal region. (Source: Europace)
Source: Europace - April 27, 2018 Category: Cardiology Source Type: research

Erratum
to: European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS) [Europace;2018: doi:10.1093/europace/euy051] (Source: Europace)
Source: Europace - April 25, 2018 Category: Cardiology Source Type: research

Untying of diagnostic decapolar catheter knot using a steerable sheath and ablation catheter
A 67-year-old man underwent electrophysiology study for typical right atrial flutter. A decapolar catheter (InquiryTM, Irvine, CA, USA) was planned to be advanced into the coronary sinus via a 7  Fr sheath in the femoral vein. Initially, manipulation with the catheter was performed without fluoroscopic guidance, with fluoroscopy it revealed a helical-shaped, knot-like structure (left panel). Gentle traction or rotation did not allow catheter withdrawal. To solve the problem, a steerable AgilisTM NxT sheath (8.5  Fr/91 cm, St. Jude Medical, MN, USA) with an 8-mm ablation catheter Alcath (Biotronik, Berl...
Source: Europace - April 20, 2018 Category: Cardiology Source Type: research

Cycle length alternans during an atypical atrioventricular nodal re-entrant tachycardia utilizing a superior slow pathway
A 71-year-old man underwent electrophysiological testing for a supraventricular tachycardia (SVT) with cycle length (CL) alternans (Panel A). At baseline, there was no pre-excitation with normal atrio-Hisian and His-ventriculo intervals, two discontinuities in the anterograde atrioventricular conduction curve were observed, ventriculoatrial conduction was concentric and decremental, and para-Hisian pacing showed a nodal pattern (Panel B). Atrial extra-stimulation induced an SVT exhibiting alterations in short and long atrio-Hisian intervals and long His-atrial intervals with an atrial activation sequence identical to that ...
Source: Europace - April 20, 2018 Category: Cardiology Source Type: research

Corrigendum
to: 2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS [Europace 2018;20:1217]. (Source: Europace)
Source: Europace - March 21, 2018 Category: Cardiology Source Type: research

2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS
Cardiac implantable electronic devicePacemakerImplantable cardioverter-defibrillatorLead-related complicationsInfectionLead extractionLead extraction techniquesIndicationsOutcome RecommendationsTrial designRegistryTrainingEHRA consensus statement (Source: Europace)
Source: Europace - March 16, 2018 Category: Cardiology Source Type: research

European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS)
AbstractEndocrine disorders are associated with various tachyarrhythmias, including atrial fibrillation (AF), ventricular tachycardia (VT), ventricular fibrillation (VF), and bradyarrhythmias. Along with underlying arrhythmia substrate, electrolyte disturbances, glucose, and hormone levels, accompanying endocrine disorders contribute to development of arrhythmia. Arrhythmias may be life-threatening, facilitate cardiogenic shock development and increase mortality. The knowledge on the incidence of tachy- and bradyarrhythmias, clinical and prognostic significance as well as their management is limited; it is represented in o...
Source: Europace - March 16, 2018 Category: Cardiology Source Type: research

Oesophagopleural fistula following epicardial ventricular tachycardia catheter ablation
A 63-year-old male, Chagas disease patient, who had a prior pacemaker implantation and syncope due to sustained ventricular tachycardia (VT) was referred for radiofrequency catheter ablation. Five years earlier cardiac magnetic resonance showed mesoepicardial inferolateral mediobasal and transmural apical late-gadolinium enhancement. Radiofrequency ablation (40  W, 17 mL/min) was performed using irrigated-tip catheter with contact a sensor (Smart Touch) on the epicardial surface of the free wall of the right ventricle (RV) and the laterobasal surface of the left ventricle. After substrate modification, VT was...
Source: Europace - March 7, 2018 Category: Cardiology Source Type: research

Erratum
to: Leadless pacemaker implantation in achondroplastic dwarfismand recurrent cardiac implantable electronic device infections: a case report [Europace 2018;20:1160]. (Source: Europace)
Source: Europace - February 16, 2018 Category: Cardiology Source Type: research

Patients ’ knowledge and attitudes regarding living with implantable electronic devices: results of a multicentre, multinational patient survey conducted by the European Heart Rhythm Association
[Europace 2018;20:386 –91]. (Source: Europace)
Source: Europace - February 15, 2018 Category: Cardiology Source Type: research

Erratum
to: Use of leadless pacemakers in Europe: results of the European Heart Rhythm Association survey [Europace 2018;20:555 –9]. (Source: Europace)
Source: Europace - February 15, 2018 Category: Cardiology Source Type: research

Split P waves: marker of extreme interatrial delay
A 38  year-old-male patient with syncope and familial PRKAG2 cardiomyopathy due to R302Q mutation was admitted in 2004 with recurrent syncope and advanced AV block for a dual chamber pacemaker implantation (Panel A). In 2017, the electrocardiogram during reprogrammed DDD pacing set at 30 beats, showed sinus bradycardia and split P waves (arrows) (Panel B), with prolonged interatrial conduction time, without split intracavitary atrial electrograms (Panel C). Longitudinal tissue Doppler biatrial strain imaging (Panels D and E) revealed the right atrial contraction curve to occur during the first P wave, while left atr...
Source: Europace - February 12, 2018 Category: Cardiology Source Type: research

Occupational radiation exposure in the electrophysiology laboratory with a focus on personnel with reproductive potential and during pregnancy: A European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart rhythm Society (HRS)
[Europace 2017;19:1909 –1922]. (Source: Europace)
Source: Europace - February 9, 2018 Category: Cardiology Source Type: research

Editorial: EP Europace - Present and Future
Dear colleagues, readers, and friends,  (Source: Europace)
Source: Europace - February 2, 2018 Category: Cardiology Source Type: research

Use of leadless pacemakers in Europe: results of the European Heart Rhythm Association survey
AbstractThe purpose of this European Heart Rhythm Association (EHRA) survey is to provide an overview of the current use of leadless pacemakers (LLPM) across a broad range of European centres. An online questionnaire was sent to centres participating in the EHRA Electrophysiology Research Network. Questions dealt with standards of care and policies used for patient management, indications, and techniques of implantation of LLPM. In total, 52 centres participated in the survey. Most (86%) reported using LLPM, although 82% of these centres implanted
Source: Europace - January 17, 2018 Category: Cardiology Source Type: research

Thoracoscopic left atrial appendage clipping as novel treatment option for peri-device leakage
A 69-year-old woman known with symptomatic antiarrhythmic drug refractory paroxysmal atrial fibrillation (AF), stroke (CHA2DS2-VASc score 5), and therapy-resistant epilepsy resulting in collapses with risk for head trauma (HAS-BLED score 3), underwent catheter ablation and transcatheter left atrial appendage (LAA) occlusion (WATCHMANTM 24  mm, Boston Scientific, Natick, MA, USA). Computed tomography (CT) scan revealed significant peri-device leakage (4–5 mm). Due to the absolute contra-indication for oral anticoagulation therapy, the patient was referred for thoracoscopic LAA-clipping (Atriclip PRO 145,...
Source: Europace - January 12, 2018 Category: Cardiology Source Type: research

Clinical impact of rotor ablation in atrial fibrillation: a systematic review
ConclusionThe wide variability in success rate between different centres performing rotor ablations suggests that the optimal ablation strategy, particularly targeting rotors, is unclear. Results from randomized studies are necessary before this technique can be considered as an established clinical tool. (Source: Europace)
Source: Europace - January 11, 2018 Category: Cardiology Source Type: research

Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA Consensus Conference
AbstractThere are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Net...
Source: Europace - January 2, 2018 Category: Cardiology Source Type: research

Leadless pacemaker implantation in achondroplastic dwarfism and recurrent cardiac implantable electronic device infections: a case report
Adaptability of micra thranscatheter pacing system (MTPS) to very small-sized patients is still an open challenge. (Source: Europace)
Source: Europace - December 29, 2017 Category: Cardiology Source Type: research

Patients ’ knowledge and attitudes regarding living with implantable electronic devices: results of a multicentre, multinational patient survey conducted by the European Heart Rhythm Association
AbstractThe purpose of this patient survey was to analyse the knowledge, experiences, and attitudes regarding cardiac implantable electronic devices (CIED) in patients with pacemakers, implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization devices. Of the 1644 patients with CIEDs from seven European countries, 88% were over 50  years of age. Most patients (90%) knew what device they were implanted with and felt sufficiently informed about the indications for therapy. As many as 42% of patients needed additional information on the battery replacement and limitations in physical activity. The sel...
Source: Europace - December 28, 2017 Category: Cardiology Source Type: research

The new European regulatory framework for medical devices: opportunities for engagement by electrophysiologists †
Since 2010, the European Society of Cardiology (ESC) has engaged with policymakers to advocate appropriate legislation and regulations to guarantee that European patients can have timely access to medical devices that are safe and effective.1 Finally, on 5 May 2017, two new European Union (EU) laws were published, concerning medical devices2 andin vitro diagnostic medical devices. These regulations replace EU directives from the 1990s, which had become outdated due to the rapid pace of technological advances and changing patterns of medical practice. From 2020, they will govern all aspects of the life cycle of medical devi...
Source: Europace - December 13, 2017 Category: Cardiology Source Type: research

Things are not always what they seem: pacemaker dysfunction or just a technical limitation?
A routinary electrocardiogram (ECG) performed in a patient with a dual-chamber pacemaker showed atrial fibrillation (AF) with abnormal stimulation spikes. What are we dealing with? (Source: Europace)
Source: Europace - December 13, 2017 Category: Cardiology Source Type: research

The use of vascular detachable coil for percutaneous closure of iatrogenic aorto-right atrial fistula
We present a 68-year-old men with paroxysmal atrial fibrillation, in whom the aorta was inadvertently punctured while obtaining transseptal access for pulmonary vein isolation. After transseptal sheath had been retracted from the aorta the patient was stable with no pericardial effusion, therefore, the leakage was left to heal. Transoesophageal echocardiography taken 2  months later revealed connection between the non-coronary sinus of Valsalva and the right atrium (RA), which measured 3 mm in diameter (PanelA). Percutaneous closure of the fistula was attempted. The fistula was intubated from the aortic side ...
Source: Europace - December 13, 2017 Category: Cardiology Source Type: research

Corrigendum
to: Coronary sinus spasm during left ventricular lead implantation for biventricular pacing [Europace 2007;9:528 –530] (Source: Europace)
Source: Europace - December 11, 2017 Category: Cardiology Source Type: research

Atrioventricular dromotropathy: evidence for a distinctive entity in heart failure with prolonged PR interval?
AbstractHeart failure (HF) is often accompanied by atrioventricular (AV) conduction disturbance, represented by prolongation of the PR interval on the electrocardiogram. Studies suggest that PR prolongation exists in at least 10% of HF patients, and it seems more prevalent in the presence of prolonged QRS duration. A prolonged PR interval may result in elevated left ventricular (LV) end-diastolic pressure, diastolic mitral regurgitation, and reduced LV pump function. This seems especially the case in patients with heart disease, in whom it is associated with an increased risk for atrial fibrillation, advanced AV heart bloc...
Source: Europace - November 24, 2017 Category: Cardiology Source Type: research

Management of ventricular tachycardia in the ablation era: results of the European Heart Rhythm Association Survey
AbstractPatients with sustained ventricular tachycardia (VT) are at risk of sudden death. Treatment options for VT include antiarrhythmic drug therapy, insertion of an implantable cardioverter-defibrillator, and catheter ablation. Evidence on indications for VT ablation, timing, ablation strategies, and periprocedural management is sparse. The aim of this European Heart Rhythm Association (EHRA) survey was to evaluate clinical practice regarding management of VT among the European countries. An electronic questionnaire was sent to members of the EHRA Electrophysiology Research Network. Responses were received from 88 centr...
Source: Europace - November 23, 2017 Category: Cardiology Source Type: research

Age, sex and the quantity of atrial fibrosis before AF ablation: what about systematic bias and confounding factors?
I read the article by Akoumet al. (1) with great interest. Their observational cohort study included a total of 939 consecutive patients with atrial fibrillation (AF) undergoing catheter ablation and 15 non-AF control group in whom late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) for atrial fibrosis quantification has been performed. As a result of the study analysis, women with AF revealed older age, higher previous history of stroke and higher left atrial fibrosis as compared to men. Female sex, persistent AF, time from AF diagnosis, and higher left atrium volume index (LAVI) were found to be independen...
Source: Europace - November 16, 2017 Category: Cardiology Source Type: research

Atrial fibrillation ablation long-term outcomes: is there light at the end of the tunnel?
This editorial refers to ‘Very long-term outcome following transcatheter ablation of atrial fibrillation. Are results maintained after 10 years of follow-up?’ by F. Gaitaet al., 20(3);443 –450. (Source: Europace)
Source: Europace - November 16, 2017 Category: Cardiology Source Type: research

Corrigendum
to: Sex differences in outcomes of primary prevention implantable cardioverter defibrillator therapy: combined registry data from eleven European countries [Europace (2017) doi:10.1093/europace/eux176] (Source: Europace)
Source: Europace - November 8, 2017 Category: Cardiology Source Type: research

Occupational radiation exposure in the electrophysiology laboratory with a focus on personnel with reproductive potential and during pregnancy: A European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS)
PregnancyOccupational exposureRadioprotectionElectrophysiology laboratory (Source: Europace)
Source: Europace - November 6, 2017 Category: Cardiology Source Type: research

Treatment of intramural ventricular tachycardia in cardiac sarcoidosis with transcoronary ethanol ablation
A 67-year-old man with sarcoidosis presented with recurrent ventricular tachycardia (VT) despite treatment with amiodarone. Cardiac magnetic resonance imaging demonstrated delayed enhancement of the mid-myocardium in the inferolateral wall and septum (Figure, upper panel) and cardiac positron emission tomography –computed tomography (PET-CT) showed a perfusion defect with increased uptake of 18F-fluorodeoxyglucose in the same region. Two inducible VTs were both mapped to the cardiac crux along the inferior interventricular septum (RBBB, superior axis and LBBB, superior axis, respectively). Prior attempts at radiofreq...
Source: Europace - November 4, 2017 Category: Cardiology Source Type: research

Arrhythmogenic right ventricular cardiomyopathy vs. dilated cardiomyopathy: implications for next-generation sequencing and microRNA regulation in appropriate diagnosis —Authors' reply
We thank Salvatore Patan è and Francesco Patanè1 for their accurate comments on our article.2 As they well pointed out, it is indeed relevant the recent advances in the micro RNA (miRNA) field and the recent discovery of the potential roll of several miRNAs in arrhythmogenic right ventricular cardiomyopathy (ARVC).3 The analysis of miRNA was out of the scope of our article, but we recognize the value of this molecules in the mechanism of the disease and their putative roll as target for novel therapies not only for ARVC but also for all cardiomyopathies.4 Interestingly, miRNAs could also be used as biomarkers...
Source: Europace - October 20, 2017 Category: Cardiology Source Type: research

Gorenek B, et al. Device-detected subclinical atrial tachyarrhythmias: definition, implications and management –an European Heart Rhythm Association (EHRA) consensus document, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE)
[Europace doi:10.1093/europace/eux163]. (Source: Europace)
Source: Europace - October 20, 2017 Category: Cardiology Source Type: research

Does CHA2DS2-VASc score predict ischaemic stroke in chronic obstructive pulmonary disease?
Chronic obstructive pulmonary disease (COPD) is associated with a high risk of ischaemic stroke.1 CHA2DS2-VASc score is recommended and is widely used for stroke risk stratification in atrial fibrillation (AF) patients,2 but it has been shown to be an independent predictor of thrombo-embolic events in patients without AF, as well.3 In this issue ofEuropace, Huet al. performed a retrospective cohort study in a very big case sample (1492 COPD patients with AF and 50  343 COPD patients without AF), and reported that COPD patients with a higher CHA2DS2-VASc score were more likely to develop ischaemic stroke whether or n...
Source: Europace - October 17, 2017 Category: Cardiology Source Type: research

Challenges in comparing the non-vitamin K antagonist oral anticoagulants for atrial fibrillation-related stroke prevention
AbstractThe aim of this review is to provide context for meta-analyses interpreting data from phase III stroke prevention studies of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (NVAF). Differences between the four phase III NOAC stroke prevention studies in patients with NVAF (ROCKET AF, ARISTOTLE, RE-LY, and ENGAGE AF), their potential impact on outcomes, and inter-study differences were evaluated, as well as the potential role of real-world evidence in evaluating NOACs in this setting. Study design differences included blinding strategy, dose-reduction options, a...
Source: Europace - October 13, 2017 Category: Cardiology Source Type: research

Is the rapidly paced pig the optimal model for endocardial cardiac resynchronization therapy? —Authors’ reply
We very much appreciate the insightful letter by Niedereret al.1 about our recent publication inEuropace.2 Most of the scientific evidence supporting the hypothetical superiority of left ventricular endocardial pacing comes from animal studies using canine models or simulation studies also based on this model.3 Unfortunately, these results have not been reproduced in clinical studies. The large multicentre prospective human trial ALternate Site Cardiac ReSYNChronization (ALSYNC), which included only patients who had failed or were unsuitable for conventional cardiac resynchronization therapy (CRT), showed that the rate of ...
Source: Europace - October 12, 2017 Category: Cardiology Source Type: research

Is the rapidly paced pig the optimal model for endocardial cardiac resynchronization therapy?
Current endocardial cardiac resynchronization therapy (CRT) is performed predominantly in non-responders to CRT.1 Previous clinical,2 pre-clinical,3 and simulation4 comparisons found endocardial CRT offered a more physiological and rapid activation pattern to epicardial CRT. In contrast the study by Amor ós-Figueraset al.5 found endocardial pacing induced similar haemodynamic changes to epicardial pacing in a porcine animal model of right ventricular (RV) pacing induced non-ischaemic cardiomyopathy. While these results are interesting, highlighting the need to identify the optimal pacing site for both epicardial and...
Source: Europace - October 12, 2017 Category: Cardiology Source Type: research