Lead performance and clinical outcomes of patients with permanent His-Purkinje system pacing: a single-centre experience
AbstractAimsHis-Purkinje system (HPS) pacing, including His bundle (HB) and left bundle branch (LBB) pacing, has emerged as a highlighted topic in recent years. Comparisons in lead performance and clinical outcomes between HB and LBB pacing were seldom reported. We aimed to investigate the mid-long-term lead performance and clinical outcomes of permanent HPS pacing patients in our centre.Methods and resultsPermanent HB pacing was implemented by placing the pacing lead helix at the HB area. Left bundle branch pacing was achieved by placing the lead helix in the left-side sub-endocardium of the interventricular septum. Pacin...
Source: Europace - December 28, 2020 Category: Cardiology Source Type: research

Electrical characteristics of pacing different portions of the His bundle in bradycardia patients
AbstractAimsHis-bundle pacing (HBP) can be achieved in either atrial-side HBP (aHBP) or ventricular-side HBP (vHBP). The study compared the pacing parameters and electrophysiological characteristics between aHBP and vHBP in bradycardia patients.Methods and resultsFifty patients undergoing HBP implantation assisted by visualization of the tricuspid valvular annulus (TVA) were enrolled. The HBP lead position was identified by TVA angiography. Twenty-five patients were assigned to undergo aHBP and compared with 25 patients who underwent vHBP primarily in a prospective and randomized fashion. Pacing parameters and echocardiogr...
Source: Europace - December 28, 2020 Category: Cardiology Source Type: research

Novel left ventricular cardiac synchronization: left ventricular septal pacing or left bundle branch pacing?
This article reviews the clinical application and differences between LVSP and LBBP. Compared with LVSP, LBBP has strict criteria for left conduction system capture and lead location. In addition to LV septal capture it also stimulates the proximal left bundle branch, resulting in rapid and physiological LV activation. With a uniformity and standardization of the implant procedure and definitions, it may be possible to achieve widespread application of this form of physiological pacing. (Source: Europace)
Source: Europace - December 28, 2020 Category: Cardiology Source Type: research

Foreword 10th Theo Rossi Di Montelera Forum on computer simulation and experimental assessment of cardiac function: towards the digital twin
What ’s new?For many years, computer modelling of physiological principles underlying the behaviour of the heart, which started during the 1970 ’s, was considered more as a hobby of engineers than as a potentially important tool for understanding how properties of microscopical components determine the macroscopical behaviour of the organ.The papers in this supplement demonstrate that computer modelling has become an essential tool for un derstanding (patho)physiological behaviour of the heart and that it is well on its way to become an essential instrument in patient management. (Source: Europace)
Source: Europace - December 26, 2020 Category: Cardiology Source Type: research

Paradigm shifts in electrophysiological mechanisms of atrial fibrillation
AbstractDetermining the sequence of activation is a major source of information for understanding the electrophysiological mechanism(s) of atrial fibrillation (AF). However, the complex morphology of the electrograms hampers their analysis, and has stimulated generations of electrophysiologists to develop a large variety of technologies for recording, pre-processing, and analysis of fibrillation electrograms. This variability of approaches is mirrored by a large variability in the interpretation of fibrillation electrograms and, thereby, opinions regarding the basic electrophysiological mechanism(s) of AF vary widely. Mult...
Source: Europace - December 24, 2020 Category: Cardiology Source Type: research

List of Reviewers
Editor-in-Chief Professor Gerhardt Hindricks and the Editorial Team would like to thank the reviewers who supported the journal in 2019-2020. (Source: Europace)
Source: Europace - December 23, 2020 Category: Cardiology Source Type: research

Understanding important factors for arrhythmogenicity associated with transcatheter aortic valve implantation including left bundle branch block
We read with interest the multicentre prospective study by Muntan é-Carolet al that demonstrated new-onset left bundle branch block (LBBB) was an indicator of high arrhythmogenicity after transcathether aortic valve implantation (TAVI).1 Whilst new tachyarrhythmic events were distributed evenly within the 2-year follow-up the majority of new high-degree atrioventricular block leading to pacemaker (PPM) implantation occurred in the initial months. (Source: Europace)
Source: Europace - December 22, 2020 Category: Cardiology Source Type: research

Efficacy and safety of left atrial appendage electrical isolation during catheter ablation of atrial fibrillation: an updated meta-analysis
AbstractAimsLeft atrial appendage electrical isolation (LAAEI) has been shown to improve freedom from all-atrial arrhythmia  recurrence in patients with non-paroxysmal atrial fibrillation (AF). The aim of this study is to investigate the long-term efficacy and safety outcomes of LAAEI in patients with non-paroxysmal AF undergoing catheter ablation.Methods and resultsA systematic review of Medline, Cochrane, and Embase was performed for clinical studies evaluating the benefit of LAAEI in non-paroxysmal AF. Nine studies with a total of 2336 patients were included (mean age: 65  ± 9 years, 63%...
Source: Europace - December 16, 2020 Category: Cardiology Source Type: research

The interpretation of CHA2DS2-VASc score components in clinical practice: a joint survey by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, the EHRA Young Electrophysiologists, the Association of Cardiovascular Nursing and Allied Professionals, and the European Society of Cardiology Council on Stroke
In conclusion, this survey revealed overall good adherence to the correct definition of each component in scoring of the ‘C’, ‘H’, and ‘V’ elements of the CHA2DS2-VASc score, although the variation in their interpretations warrants further clarifications. The preferred referencing resources to calculate the score varied among different healthcare professionals. Guideline education to healthcare professionals and updated and unified online/mobile scoring tools are suggested to improve the accuracy in scoring the CHA2DS2-VASc score. (Source: Europace)
Source: Europace - December 12, 2020 Category: Cardiology Source Type: research

Comparative data on left atrial appendage occlusion efficacy and clinical outcomes by age group in the Amplatzer ™ Amulet™ Occluder Observational Study
This study aimed to summarize the impact of aging on LAAO outcomes at short and long-term follow-up.Methods and resultsWe compared subjects aged
Source: Europace - December 6, 2020 Category: Cardiology Source Type: research

Left atrial or left atrial appendage thrombus as a cardiac source of embolus: that is the question or Faust bargain for left atrial appendage closure? —Authors’ reply
We thank Yakutet al. for their comments on our Point of view ‘Where are clots in atrial fibrillation? Did we have the wrong assumptions over the last decades?’. In the manuscript, we addressed how in the old literature the frequency of left atrial cavity thrombi is probably largely overestimated.1 In fact, based on an accurate review, and on our experience, the real frequency of atrial thrombi located outside the left appendage (LAA) is extremely low, and it might be an important rationale for LAA occlusion interventions. The aim of this last sentence was to give evidence to procedures focusing on LAA, not prom...
Source: Europace - November 30, 2020 Category: Cardiology Source Type: research

Left atrial or left atrial appendage thrombus as a cardiac source of embolus: that is the question or Faustian bargain for left atrial appendage closure?
We read with great interest the article by Crestiet al.1 titled, ‘Where are clots in atrial fibrillation? Did we have the wrong assumptions over the last decades?’ speculating that the very low real frequency of left atrial (LA) thrombi out of the LA appendage (LAA) in more modern reports might be an important rationale for LAA closure (LAAc). As authors stat ed that it is time to have a closer look at the true source of cardiac embolus concerning LA or LAA origin. We want to address some points that merit more attention. (Source: Europace)
Source: Europace - November 30, 2020 Category: Cardiology Source Type: research

Erratum to: Left atrial fibrosis predicts left ventricular ejection fraction response after atrial fibrillation ablation in heart failure patients: the Fibrosis-HF Study
[Europace 2020;doi:10.1093/europace/euaa179] (Source: Europace)
Source: Europace - November 30, 2020 Category: Cardiology Source Type: research

Safety, efficacy, and reproducibility of cavotricuspid isthmus ablation guided by the ablation index: acute results of the FLAI study
ConclusionAI-guided ablation with an inter-lesion distance ≤6 mm represents an effective, safe, and highly reproducible strategy to achieve bidirectional block in the treatment of typical AFL. (Source: Europace)
Source: Europace - November 19, 2020 Category: Cardiology Source Type: research

Prognostic impact of multiple fragmented QRS on cardiac events in idiopathic dilated cardiomyopathy
AbstractAims  To evaluate the prognostic impact of fragmented QRS (fQRS) on idiopathic dilated cardiomyopathy (DCM).Methods and results  We conducted a prospective observational study of 290 consecutive patients with DCM (left ventricular ejection fraction ≤ 40%) and narrow QRS who underwent cardiac magnetic resonance. We defined fQRS as the presence of various RSR′ patterns in ≥2 contiguous leads representing the anterior (V1–V5), inferior (II, III, and aVF), or lateral (I, aVL, and V6) myocardial segments. Multiple fQRS was defined as the pr esence of fQRS in ≥2 myocardial segments. Patient...
Source: Europace - November 19, 2020 Category: Cardiology Source Type: research

Randomized comparison of oesophageal protection with a temperature control device: results of the IMPACT study
Conclusion  Thermal protection of the oesophagus significantly reduces ablation-related thermal injury compared with standard care. This method of oesophageal protection is safe and does not compromise the efficacy or efficiency of the ablation procedure. (Source: Europace)
Source: Europace - November 17, 2020 Category: Cardiology Source Type: research

The 3-month post-atrial fibrillation ablation blanking period: time to redefine?
This editorial refers to ‘Predictive role of early recurrence of atrial fibrillation after cryoballoon ablation’ by G. Stabileet al., on pages 1798--1804. (Source: Europace)
Source: Europace - November 16, 2020 Category: Cardiology Source Type: research

Permanent atrial fibrillation in women: the prevalent role of risk factors and specific mechanisms determining outcome and quality of life
This editorial refers to ‘Sex-related differences in risk factors, outcome, and quality of life in patients with permanent atrial fibrillation: results from the RACE II study’ by M. Kloostermanet al., on pages1619--1627. (Source: Europace)
Source: Europace - November 10, 2020 Category: Cardiology Source Type: research

Fatal aortic dissection associated with catheter ablation
A 73-year-old woman with left ventricular (LV) non-compaction cardiomyopathy, severely depressed LV systolic function (ejection fraction of 28%), and a high burden (31%) of monomorphic premature ventricular complexes was referred for catheter ablation. Because of suspected LV summit origin, retrograde access was established. A short sheath (8-Fr × 11 cm), which was subsequently exchanged for a long one (8.5-Fr × 63 cm), was introduced through the right femoral artery and a 4-mm-tip irrigated ablation catheter (FlexAbility™, Abbott, Chicago, IL, USA) was advanced into the aorta and the left v...
Source: Europace - November 9, 2020 Category: Cardiology Source Type: research

Screening and surveillance of atrial fibrillation with continuous vs. intermittent monitoring: a false choice?
This editorial refers to ‘Screening for atrial fibrillation: predicted sensitivity of short, intermittent ECG recordings in an asymptomatic at-risk population’ by G. Queret al., on pages1781--1787. (Source: Europace)
Source: Europace - November 9, 2020 Category: Cardiology Source Type: research

Electrocardiographic predictors of infrahissian conduction disturbances in myotonic dystrophy type 1
ConclusionThe combination of a prolonged PR interval and widened QRS complex on ECG accurately predicts abnormal infrahissian conduction on EPS in patients with DM1. These ECG parameters could be used as a screening tool to determine the need for referral to a specialized multidisciplinary neuromuscular team with EPS capacity. (Source: Europace)
Source: Europace - November 5, 2020 Category: Cardiology Source Type: research

Complications in pulmonary vein isolation in the Netherlands Heart Registration differ with sex and ablation technique
Conclusion  The reported complication rate during PVI was low. Patients treated with C-RF ablation were more likely to develop cardiac tamponades and vascular complications. Female sex was associated with more cardiac tamponade and bleeding complications. (Source: Europace)
Source: Europace - November 3, 2020 Category: Cardiology Source Type: research

Implantation technique and optimal subcutaneous defibrillator chest position: a PRAETORIAN score-based study
AbstractAimsThe traditional technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation involves three incisions and a subcutaneous pocket. Recently, a two-incision and intermuscular (IM) technique has been adopted. The PRAETORIAN score is a chest radiograph-based tool that predicts S-ICD conversion testing. We assessed whether the S-ICD implantation technique affects optimal position of the defibrillation system according to the PRAETORIAN score.Methods and resultsWe analysed consecutive patients undergoing S-ICD implantation. The χ2 test and regression analysis were used to determine the as...
Source: Europace - October 29, 2020 Category: Cardiology Source Type: research

Anxiety and depression symptoms in Danish patients with an implantable cardioverter-defibrillator: prevalence and association with indication and sex up to 2 years of follow-up (data from the national DEFIB-WOMEN study)
ConclusionPatients with a SPI reported higher anxiety and depression scores as compared to patients with PPI. Women reported higher anxiety scores than men, but only higher depression scores at baseline. Women with SPI reported the highest anxiety and depression scores overall. (Source: Europace)
Source: Europace - October 27, 2020 Category: Cardiology Source Type: research

Non-invasive detection of exercise-induced cardiac conduction abnormalities in sudden cardiac death survivors in the inherited cardiac conditions
AbstractAims  Rate adaptation of the action potential ensures spatial heterogeneities in conduction across the myocardium are minimized at different heart rates providing a protective mechanism against ventricular fibrillation (VF) and sudden cardiac death (SCD), which can be quantified by the ventricular conduction stability (V-CoS) test previously described. We tested the hypothesis that patients with a history of aborted SCD due to an underlying channelopathy or cardiomyopathy have a reduced capacity to maintain uniform activation following exercise.Methods and results  Sixty individuals, with (n =&thin...
Source: Europace - October 21, 2020 Category: Cardiology Source Type: research

Arrhythmic burden in patients with new-onset persistent left bundle branch block after transcatheter aortic valve replacement: 2-year results of the MARE study
ConclusionPatients with new-onset LBBB post-TAVR exhibited a very high burden of arrhythmic events within the 2  years post-procedure. While new tachyarrhythmic events were homogeneously distributed over time, the vast majority of new HAVB episodes leading to PPM implantation occurred early after the procedure. These results should help to guide the management of this challenging group of patients. (clinica ltrials.gov: NCT02153307) (Source: Europace)
Source: Europace - October 21, 2020 Category: Cardiology Source Type: research

Diagnosis, family screening, and treatment of inherited arrhythmogenic diseases in Europe: results of the European Heart Rhythm Association Survey
AbstractThe spectrum of inherited arrhythmogenic diseases (IADs) includes disorders without overt structural abnormalities (i.e. primary inherited arrhythmia syndromes) and structural heart diseases (i.e. arrhythmogenic ventricular cardiomyopathy, hypertrophic cardiomyopathy). The aim of this European Heart Rhythm Association (EHRA) survey was to evaluate current clinical practice and adherence to 2015 European Society of Cardiology Guidelines regarding the management of patients with IADs. A 24-item centre-based online questionnaire was presented to the EHRA Research Network Centres and the European Cardiac Arrhythmia Gen...
Source: Europace - October 21, 2020 Category: Cardiology Source Type: research

Complementary effectiveness of carotid sinus massage and tilt testing for the diagnosis of reflex syncope in patients older than 40 years: a cohort study
ConclusionThe overall diagnostic yield of the tests in patients>40-year-old with suspected reflex syncope was 61%. Both CSM and TT are useful for identifying those patients with a bradycardic phenotype, whereas CSM has a limited value for identifying the hypotensive phenotype. Since the overlap of responses between tests is minimal, both CSM and TT should be performed in every patient over 40  years receiving investigation for unexplained but possible reflex syncope. (Source: Europace)
Source: Europace - October 20, 2020 Category: Cardiology Source Type: research

Avoiding implant complications in cardiac implantable electronic devices: what works?
AbstractNearly one in ten patients experience complications in relation to cardiac implantable electronic device (CIED) implantations. CIED complications have serious implications for the patients and for the healthcare system. In light of the rising rates of new implants and consistent rate of complications, primary prevention remains a major concern. To guide future efforts, we sought to review the evidence base underlying common preventive actions made during a primary CIED implantation. (Source: Europace)
Source: Europace - October 16, 2020 Category: Cardiology Source Type: research

Association of anticoagulant therapy with risk of dementia among patients with atrial fibrillation
ConclusionIn this propensity-matched and -weighted analysis using a real-world population-based cohort, use of NOACs was associated with lower dementia risk than use of warfarin among non-valvular AF patients initiating OAC treatment. (Source: Europace)
Source: Europace - October 16, 2020 Category: Cardiology Source Type: research

Magnetic resonance-guided re-ablation for atrial fibrillation is associated with a lower recurrence rate: a case –control study
ConclusionThe substrate characterization provided by DE-CMR facilitates the identification of anatomical veno-atrial gaps and associates with shorter procedures and better clinical outcomes in repeated AF ablation procedures. (Source: Europace)
Source: Europace - October 16, 2020 Category: Cardiology Source Type: research

Recurrent syncope in paced patients, hitherto ignored?
This editorial refers to ‘Risk of syncopal recurrences in patients treated with permanent pacing for bradyarrhythmic syncope: role of correlation between symptoms and ECG findings’ by P. Palmisanoet al., on pages 1729--1736. (Source: Europace)
Source: Europace - October 15, 2020 Category: Cardiology Source Type: research

Ventricular tachycardia catheter ablation after repaired tetralogy of Fallot: how to overcome an electrical short circuit
A 30 ‐year‐old man with a history of surgical repair of tetralogy of Fallot and percutaneous pulmonary valve replacement (Melody, Medtronic, Minneapolis, MN, USA) was admitted for sustained ventricular tachycardia (VT) with a rate of 160 b.p.m., inferior axis and right bundle branch block morphology. The patient was scheduled for radiofrequency catheter ablation (RFCA) and pre-procedural multislice computed tomography was performed. At the electrophysiological study, an activation map during ongoing VT did show an “early-meets-late” pattern between the right ventricular outflow tract ant th e tricuspid valv...
Source: Europace - October 14, 2020 Category: Cardiology Source Type: research

Low-voltage bridge strategy to guide cryoablation of typical and atypical atrioventricular nodal re-entry tachycardia in children: mid-term outcomes in a large cohort of patients
ConclusionThe LVB ablation strategy is very effective in AVNRT treatment in children. Recurrences are related to the complexity of the arrhythmogenic substrate. (Source: Europace)
Source: Europace - October 10, 2020 Category: Cardiology Source Type: research

Self-reported treatment burden in patients with atrial fibrillation: quantification, major determinants, and implications for integrated holistic management of the arrhythmia
AbstractAims  Treatment burden (TB) refers to self-perceived cumulative work patients do to manage their health. Using validated tools, TB has been documented in several chronic conditions, but not atrial fibrillation (AF). We measured TB and analysed its determinants and impact on quality of life (QoL) in an AF cohort.Methods and results  A single-centre study prospectively included consecutive adult AF patients and non-AF controls managed from 1 April to 21 June 2019, who voluntarily and anonymously answered the TB questionnaire (TBQ) and 5-item EQ-5D QoL questionnaire; TB was calculated as a sum of TBQ points ...
Source: Europace - October 10, 2020 Category: Cardiology Source Type: research

Incidence, characteristics, determinants, and prognostic impact of recurrent syncope
Conclusion  Recurrence rates of syncope are substantial and vary depending on syncope aetiology. Importantly, recurrent syncope carries a time-dependent increased risk for death and MACE.Trial registrationBAsel Syncope EvaLuation (BASEL IX, ClinicalTrials.gov registry number NCT01548352). (Source: Europace)
Source: Europace - October 10, 2020 Category: Cardiology Source Type: research

Risk of syncopal recurrences in patients treated with permanent pacing for bradyarrhythmic syncope: role of correlation between symptoms and electrocardiogram findings
AbstractAims  To evaluate the risk of syncopal recurrences after pacemaker implantation in a population of patients with syncope of suspected bradyarrhythmic aetiology.Methods and results  Prospective, multicentre, observational registry enrolling 1364 consecutive patients undergoing pacemaker implantation for syncope of bradyarrhythmic aetiology (proven or presumed). Before pacemaker implantation, all patients underwent a cardiac work-up in order to establish the bradyarrhythmic aetiology of syncope. According to the results of the diagnostic work-up, patients were divided into three groups: Group A, patients in...
Source: Europace - October 10, 2020 Category: Cardiology Source Type: research

Emerging electromagnetic interferences between implantable cardioverter-defibrillators and left ventricular assist devices
We appreciated very much the paper by Yalcinet al.,1 recently published inEuropace. Authors investigated the prevalence of electromagnetic interference (EMI) between left ventricular assist devices (LVADs) and implantable cardioverter-defibrillators (ICDs)/pacemakers (PMs) since most patients who are eligible for LVAD therapy already have an ICD and/or PM implanted.  AQ (Source: Europace)
Source: Europace - October 6, 2020 Category: Cardiology Source Type: research

Emerging electromagnetic interferences between implantable cardioverter-defibrillators and left ventricular assist devices: Authors ’ reply
We have read with interest the letter from colleagues Guiseppe Coppola and Enrico Bonni from Palermo, Italy and would like to thank for their useful comments1. (Source: Europace)
Source: Europace - October 6, 2020 Category: Cardiology Source Type: research

Knowledge gaps, lack of confidence, and system barriers to guideline implementation among European physicians managing patients with CIED lead or infection complications: a European Heart Rhythm Association/European Society of Cardiology educational needs assessment survey
AbstractAs the number of patients with cardiac implantable electronic devices (CIEDs) grows, they are likely to present with issues to diverse groups of physicians. Guideline-adherent management is associated with improved prognosis in patients with CIED infection or lead problems but is insufficiently implemented in practice. The European Heart Rhythm Association (EHRA) with the support of the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery, performed a multinational educational needs assessment study in ESC member countries, directed at physicians who might be confronted with CIED patients wi...
Source: Europace - October 4, 2020 Category: Cardiology Source Type: research

Relation of outcomes to ABC (Atrial Fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: an analysis from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) Registry
AbstractAimsThere has been an increasing focus on integrated, multidisciplinary, and holistic care in the treatment of atrial fibrillation (AF). The ‘Atrial Fibrillation Better Care’ (ABC) pathway has been proposed to streamline integrated care in AF. We evaluated the impact on outcomes of an ABC adherent management in a contemporary real-life European-wide AF cohort.Methods and resultsPatients enrolled in the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry with baseline data to evaluate ABC criteria and available follow-up data were considered for this analysis. Among the original...
Source: Europace - October 2, 2020 Category: Cardiology Source Type: research

Predictive role of early recurrence of atrial fibrillation after cryoballoon ablation
AbstractAimsThe aims of this study were to determine the rate and the predictors of early recurrences of atrial fibrillation (ERAF) after cryoballoon (CB) ablation and to evaluate whether ERAF correlate with the long-term outcome.Methods and resultsThree thousand, six hundred, and eighty-one consecutive patients (59.9  ± 10.5 years, female 26.5%, and 74.3% paroxysmal AF) were included in the analysis. Atrial fibrillation recurrence, lasting at least 30 s, was collected during and after the 3-month blanking period. Three-hundred and sixteen patients (8.6%) (Group A) had ERAF during the bla...
Source: Europace - October 2, 2020 Category: Cardiology Source Type: research

Inflammation and adiposity: new frontiers in atrial fibrillation
AbstractThe aetiology of atrial fibrillation (AF) remains poorly understood, despite its growing prevalence and associated morbidity, mortality, and healthcare costs. Obesity is implicated in myriad different disease processes and is now recognized a major risk factor in the pathogenesis of AF. Moreover, the role of distinct adipose tissue depots is a matter of intense scientific interest with the depot directly surrounding the heart —epicardial adipose tissue (EAT) appearing to have the greatest correlation with AF presence and severity. Similarly, inflammation is implicated in the pathophysiology of AF with EAT tho...
Source: Europace - October 2, 2020 Category: Cardiology Source Type: research

Screening for atrial fibrillation: predicted sensitivity of short, intermittent electrocardiogram recordings in an asymptomatic at-risk population
AbstractAimsScreening for asymptomatic atrial fibrillation (AF) could prevent strokes and save lives, but the AF burden of those detected can impact prognosis. New technologies enable continuous monitoring or intermittent electrocardiogram (ECG) snapshots, however, the relationship between AF detection rates and the burden of AF found with intermittent strategies is unknown. We simulated the likelihood of detecting AF using real-world 2-week continuous ECG recordings and developed a generalizable model for AF detection strategies.Methods and resultsFrom 1738 asymptomatic screened individuals, ECG data of 69 individuals (me...
Source: Europace - September 30, 2020 Category: Cardiology Source Type: research

Electrophysiology in the time of coronavirus: coping with the great wave
AbstractAims  To chart the effect of the COVID-19 pandemic on the activity of interventional electrophysiology services in affected regions.Methods and results  We reviewed the electrophysiology laboratory records in three affected cities: Wenzhou in China, Milan in Italy, and London in the UK. We inspected catheter lab records and interviewed electrophysiologists in each centre to gather information on the impact of the pandemic on working patterns and on the health of staff members and patients. There was a striking decline in interventional electrophysiology activity in each of the centres. The decline occurre...
Source: Europace - September 30, 2020 Category: Cardiology Source Type: research

Late gadolinium enhancement role in arrhythmic risk stratification of patients with LMNA cardiomyopathy: results from a long-term follow-up multicentre study
ConclusionsIn LMNA-CMP patients, LGE at baseline CMR is significantly associated with MVA. In particular, as suggested by this preliminary experience, the absence of LGE allowed to rule-out MVA at 10  years mean FU. (Source: Europace)
Source: Europace - September 30, 2020 Category: Cardiology Source Type: research

Simultaneous pacing of left anterior/posterior fascicular areas as an alternative to left bundle branch pacing: a case report
A 68-year-old man, who underwent a mechanical aortic valve replacement, was diagnosed with heart failure, complete atrioventricular block, and right ventricular (RV) escape rhythm. After admission, left bundle branch pacing was planned. However, due to the influence of the mechanical aortic valve, it was failed. In the end, in order to stay away from the scar under the metal valve, simultaneous pacing of left anterior fascicular area (LAFa) combined with left posterior fascicular area (LPFa) for treatment was proposed. Under the guidance of a C315-His sheath, two 3830-69 electrodes were successfully rotated into the LAFa a...
Source: Europace - September 28, 2020 Category: Cardiology Source Type: research

Management of ventricular electrical storm: a contemporary appraisal
AbstractVentricular electrical storm (VES) is a clinical scenario characterized by the clustering of multiple episodes of sustained ventricular arrhythmias (VA) over a short duration. Patients with VES are prone to psychological disorders, heart failure decompensation, and increased mortality. Studies have shown that 10 –28% of the patients with secondary prevention ICDs can sustain VES. The triad of a susceptible electrophysiologic substrate, triggers, and autonomic dysregulation govern the pathogenesis of VES. The rate of VA, underlying ventricular function, and the presence of implantable cardioverter-defibril lat...
Source: Europace - September 27, 2020 Category: Cardiology Source Type: research

The ‘double transition’: a novel electrocardiogram sign to discriminate posteroseptal accessory pathways ablated from the right endocardium from those requiring a left-sided or epicardial coronary venous approach
ConclusionThe combination of a q wave in V1 with a double QRS transition pattern in the precordial leads is highly specific of a right endocardial AP and rules out the need for CS or left-sided mapping. (Source: Europace)
Source: Europace - September 27, 2020 Category: Cardiology Source Type: research

A unified theory for the circuit of atrioventricular nodal re-entrant tachycardia
AbstractAtrioventricular nodal re-entrant tachycardia (AVNRT) is the most common regular tachycardia in the human, but its exact circuit remains elusive. In this article, recent evidence about the electrophysiological characteristics of AVNRT and new data on the anatomy of the atrioventricular node, are discussed. Based on this information, a novel, unified theory for the nature of the circuit of the tachycardia is presented. (Source: Europace)
Source: Europace - September 26, 2020 Category: Cardiology Source Type: research