21 Thromboembolic events in left ventricular endocardial pacing: long-term outcomes from a Multicentre UK registry
We examined if the long-term thromboembolic risk in this cohort is significant and related to any patient or procedural characteristics. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

2 A multi-centre study into the use of Ripple Mapping to differentiate atrial scar from conducting tissue during tachycardia ablation
Background: Atrial tachycardias (AT) that occur following previous ablation arise secondary to iatrogenic scar predisposing to reentry. There exists no bipolar voltage threshold that defines scar with 3D mapping. Ripple Mapping (RM), developed in our institution, displays each mapped electrogram (EGM) as a moving bar at its acquired 3D location relative to a stable fiducial reference, and is displayed over a bipolar voltage map. We developed an approach to differentiate atrial scar from conducting tissue using RM as a guide to ablation, and tested this approach in new users mapping post-AF-ablation ATs. (Source: Europace)
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

1 Non-invasive detection of exercise induced cardiac conduction abnormalities in sudden cardiac death survivors in the inherited arrhythmic syndromes
Introduction: Rate adaptation of the action potential ensures spatial heterogeneities in conduction across the myocardium are minimised at different heart rates which provides a physiologically protective mechanism against the development of ventricular fibrillation (VF) and sudden cardiac death (SCD). Whilst beat to beat whole heart activation patterns may be characterised with current electroanatomical mapping techniques, quantifying these changes remains a challenge. We developed a method to rapidly quantify changes in ventricular activation in response to rate cycle length changes as a surrogate for abnormalities in ra...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

Arrhythmogenic right ventricular cardiomyopathy: implications of next-generation sequencing and of miRNAs regulation in appropriate understanding and treatment
We read the article by Medeiros-Domingoet al.1 with great interest and congratulate the authors on their excellent work. As the authors correctly state, currently, nearly 40% of the patients with an arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC) phenotype according to the task force 2010 criteria remain genetically elusive. By using whole-exome sequencing and analysing the protein coding exons and flanking splice sites of 96 genes associated with cardiomyopathies and channelopathies, they found rare genetic variants that may explain the phenotype in 64% of the cases.1 However, we would like to call attent...
Source: Europace - October 4, 2017 Category: Cardiology Source Type: research

Migration of an ‘injectable’ loop recorder in the dorsal pleural cavity
The BioMonitor 2, Biotronik is provided with a specifically designed insertion tool set which allows easy sub-dermal insertion. Due to an excessive angle of penetration, of about 40 °, the pocket tool was inadvertently inserted in the 4° intercostal space until the pleural cavity. The implantable loop recorder was placed in a support tool and both were inserted together straight into the pre-shaped pocket. A latero-lateral Rx ray image showed that the loop recorder migrated i nto the left pleural cavity and was finally located in its postero-inferior recess. The device could be interrogated and properly programmed....
Source: Europace - September 28, 2017 Category: Cardiology Source Type: research

Estimation of the effects of multipoint pacing on battery longevity in routine clinical practice
AbstractAimsMultipoint pacing (MPP) permits simultaneous multisite pacing of the left ventricle (LV); initial studies suggest haemodynamic and clinical benefits over conventional (single LV site) cardiac resynchronization therapy (CRT). The aim of this study was to estimate the impact of MPP activation on battery longevity in routine clinical practice.Methods and resultsPatient (n = 46) and device data were collected from two centres at least 3 months after MPP-CRT device implantation. Multipoint pacing programming was based on the maximal possible anatomical LV1/LV2 separation according to three prede...
Source: Europace - September 23, 2017 Category: Cardiology Source Type: research

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation
AblationArrhythmiaAtrial fibrillationAtrial flutterAtrial tachycardiaCatheter ablationSurgical ablationStrokeAnticoagulation (Source: Europace)
Source: Europace - September 15, 2017 Category: Cardiology Source Type: research

2017  HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary
AblationArrhythmiaAtrial fibrillationAtrial flutterAtrial tachycardiaCatheter ablationSurgical ablationStrokeAnticoagulation (Source: Europace)
Source: Europace - September 15, 2017 Category: Cardiology Source Type: research

The double adenosine test: a simple and non-invasive tip to unmask unapparent pre-excitations: an example of Mahaim fibres
We report the case of a 16-year-old youth who was admitted for a wide QRS tachycardia caused by an atypical atriofascicular bypass tract (the so-called ‘Mahaim fibers’). These bypass tracts give rise to antidromic atrioventricular re-entrant tachycardias, in which the bypass tract serves as the anterograde limb of the circuit and the atrioventricular node as the retrograde limb of the re-entrant circuit. Unfortunately, in these patients, it is easy to make a misdiagnosis of supraventricular tachycardia with functional left bundle branch block or even of ventricular tachycardia. Indeed, due to the slow and decre...
Source: Europace - September 12, 2017 Category: Cardiology Source Type: research

Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulaci ón Cardíaca y Electrofisiología (SOLEACE)
AbstractAtrial fibrillation (AF) is a major worldwide public health problem, and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on ‘non-valvular AF’ patients. Thrombo-embolic risk also varies according to valve lesion and may also be associated with CHA2DS2VASc score risk factor components, rather than only the valve disease being causal. Given marked heterogeneity in the definition of valvular and non-valvular AF and variable management strategies, including no...
Source: Europace - August 30, 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 - August 30, 2017 Category: Cardiology Source Type: research

Long-term impact of intrathoracic impedance findings on survival and heart failure hospitalizations after cardiac resynchronization therapy in ICD Registry patients
AbstractAimsTo determine adjusted associations among OptiVol® threshold crossings, long-term survival, and hospitalizations among heart failure (HF) patients with Medicare coverage in the United States.Methods and resultsA cohort with OptiVol®-enabled cardiac resynchronization therapy defibrillators (CRT-D) devices from the Implantable Cardioverter Defibrillator Registry was linked to both Medicare claims/summary data and Medtronic ’s CareLink® Network data. An extended multivariable Cox model was used to analyse associations among OptiVol® threshold crossings (treated as time-dependent covariates), m...
Source: Europace - August 25, 2017 Category: Cardiology Source Type: research

Guerra F, et al. Symptomatic atrial fibrillation and risk of cardiovascular events: data from the Euro Heart Survey
[Europace doi:10.1093/europace/eux205] (Source: Europace)
Source: Europace - August 24, 2017 Category: Cardiology Source Type: research

Pacemaker implantation and mortality: no role as a quality control indicator: Author ’s reply
We thank Dr Brough for her interest in our article. She provided additional data in her letter1 that further corroborate our findings i.e. mortality after device implantation (permanent pacemaker, ICD, CRT) is related to patients ’ underlying comorbid conditions including advanced age.2 Taken together, these data indicate that mortality is not a useful parameter for assessing and comparing quality or for public reporting of individual or institutional quality for device implantation. These findings highlight the need for future research to identify a more meaningful and robust marker to determine not only the quality...
Source: Europace - August 19, 2017 Category: Cardiology Source Type: research

How to prevent atrial oesophageal fistula following ablation of atrial fibrillation: are there actually any effective methods? —Authors’ reply
We would like to thank Dr Giulio Zucchelli and colleagues1 for their letter regarding our recent report, which highlighted atrial oesophageal fistula (AEF), a severe complication of atrial fibrillation (AF) catheter ablation, and presenting very high-mortality rate in that population.2 (Source: Europace)
Source: Europace - August 10, 2017 Category: Cardiology Source Type: research

To downgrade, or not to downgrade: that is the question
I have read with great interest the review paper entitled ‘Cardiac resynchronization therapy (CRT) device replacement considerations: upgrade or downgrade? A complex decision in the current clinical setting’ by Nakouet al. in the latest issue of the journal.1 They nicely summarized and commented on device selection at the time of replacement, considering patient ’s history, demographics, clinical characteristics, and currently available scientific knowledge. Some important issues, however, should be mentioned; (i) Super response to cardiac resynchronization therapy (CRT) seems as a remission process, not ...
Source: Europace - August 10, 2017 Category: Cardiology Source Type: research

The effect of ventricular pre-excitation on ventricular wall motion and left ventricular systolic function
Conclusion  Right-sided accessory pathways may impair ventricular wall motion and LV systolic function, resulting in decreased LV ejection fraction and increased LV end-diastolic diameter. These effects occurred in patients with LV dyssynchrony. These effects, including LV dyssynchrony, resolved after radiofrequency ablation. A right-sided free-wall accessory pathway may have more detrimental effects than a septal accessory pathway. Left ventricular dyssynchrony and abnormal interventricular septal motion appeared to be responsible for the pathogenesis of LV dysfunction and remodelling. (Source: Europace)
Source: Europace - August 9, 2017 Category: Cardiology Source Type: research

Association between socioeconomic factors and ICD implantation in a publicly financed health care system: a Danish nationwide study
AbstractAimsFor patients surviving out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, implantable cardioverter defibrillator (ICD) is recommended for non-reversible causes of arrest. We aimed to determine factors associated with implantation of ICD and survival in patients surviving non-AMI OHCA in a nationwide register covering all OHCAs in Denmark.Methods and resultsWe identified 36  950 OHCAs between 2001 and 2012, 1700 of whom were ICD naïve, ≥18 years, of non-AMI cardiac aetiology and surviving until discharge. Six hundred fifty eight patients had ICD implanted during index admission....
Source: Europace - August 9, 2017 Category: Cardiology Source Type: research

Age and sex differences in atrial fibrosis among patients with atrial fibrillation
AbstractAimAge and female sex are associated with a higher risk of stroke in atrial fibrillation (AF). We sought to determine whether advancing age and female sex are associated with higher atrial fibrosis.Methods and results  We conducted an observational cohort study of patients with AF enrolled in the University of Utah AF Database and a non-AF control group who underwent late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) for atrial fibrosis quantification. Participants with contra-indications for contrast MRI scanning were excluded. Nine hundred and eight consecutive men and women with AF and 15 non-...
Source: Europace - August 9, 2017 Category: Cardiology Source Type: research

Predictors of long-term survival free from relapses after extraction of infected CIED
AbstractAimsWe explored the possible predictors of long-term prognosis after transvenous lead extraction (TLE) for a cardiac implantable device related infection (CIEDI), including the modified Duke score result.Methods and resultsWe performed a single centre prospective observational study in a population of consecutive patients referred for TLE to a teaching hospital to treat a CIEDI without associated valve-endocarditis. 121 patients were enrolled between January 2012 and March 2016. According to the modified Duke criteria, the presence of CIED-related endocarditis was rejected in 54.5%, possible in 21.5%, and definite ...
Source: Europace - August 9, 2017 Category: Cardiology Source Type: research

Successful implant of a leadless pacemaker with tine-based fixation next to an abandoned battery-depleted screw-in helix fixation leadless device
An 84-year old man was admitted with presyncope due to battery failure of a leadless pacemaker (Nanostim ™ St. Jude Medical) which had been implanted for bradyarrhythmias in 2014. Based on the presence of an occlusion in the subclavian vein and the patient’s preferences a leadless pacemaker (Micra™ Medtronic) was chosen as replacement. As the patient had concerns about complications from an extra ction procedure the replacement device was implanted without extraction of the dysfunctional leadless pacemaker. Access was through the femoral vein using a 23-French introducer. The device was placed at the mid-...
Source: Europace - August 9, 2017 Category: Cardiology Source Type: research

Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage
ConclusionIn our population with a high proportion of complex CHD, CTI-related IART was the most frequent mechanism, although non-CTI-related IART was present in 49% of patients (alone or with concomitant CTI-related IART). A cut-off voltage of 0.5  mV could identify 95.4% of the substrates in non-CTI-related IART. (Source: Europace)
Source: Europace - August 9, 2017 Category: Cardiology Source Type: research

Upgrading or downgrading a cardiac resynchronization therapy device (CRT) device? Gaps and dilemmas in current clinical practice
We thank Cayet al.1 for the precise comments and observations in our recent publication in Europace entitled ‘Cardiac resynchronization therapy (CRT) device replacement considerations: upgrade or downgrade? A complex decision in the current clinical setting’.2 In their letter to the editor, they highlight some important issues regarding the CRT device selection at the time of replacement:In the randomized trial published by Cayet al.3, the echocardiographic parameters and clinical endpoints deteriorated after the deactivation of their bi-ventricular pacing activities shedding further light on CRT replacement co...
Source: Europace - August 9, 2017 Category: Cardiology Source Type: research

Approach to cardio-oncologic patients with special focus on patients with cardiac implantable electronic devices planned for radiotherapy: results of the European Heart Rhythm Association survey
AbstractThe aim of this European Heart Rhythm Association (EHRA) survey was to evaluate clinical practice regarding cardio-oncologic patients, with special focus on patients with cardiac implantable electronic devices (CIEDs) planned for anticancer radiotherapy (RT), among members of the EHRA electrophysiology research network. Of the 36 responding centres, 89% managed patients who were diagnosed or treated oncologically, and this diagnosis affected 1 –5% of cardiovascular patients in majority of centres (57%). The main side effects of anticancer therapy in patients treated by cardiologists were thromboembolic compli...
Source: Europace - August 8, 2017 Category: Cardiology Source Type: research

Emerging molecular therapies targeting myocardial infarction-related arrhythmias: the role of miRNAs regulation
We read the article by Driessenet al.1 with great interest, and congratulate the authors on their excellent work. As the authors correctly state, an approach to speed conduction and prevent re-entry-based arrhythmias in myocardial infarction (MI) may stem from interference with the micro-RNA, miR1.1 However, we would like to point out two important aspects. First, there is evidence that miR-1231 is overexpressed after MI insults while calcium channel voltage-dependent alpha 2/delta subunit 2 (Cacna2d2) (identified as the target of miR-1231) is suppressed by miR-1231 and that the forced overexpression of miR-1231 promotes a...
Source: Europace - August 7, 2017 Category: Cardiology Source Type: research

The bipolar ablation of refractory typical atrial flutter with CARTO 3 Confidense system
The main target of typical atrial flutter ablation is to create bidirectional block in the cavotricuspid isthmus. In unsuccessful cases, the bipolar ablation can be applied, however there are only a few published cases. (Source: Europace)
Source: Europace - August 4, 2017 Category: Cardiology Source Type: research

CHA2DS2-VASc score and blood biomarkers to identify patients with atrial high rate episodes and paroxysmal atrial fibrillation: the role of TIMP-4 regulation —Authors’ reply
In our patient cohort, we have investigated a biomarker pattern with discriminatory potential for the prevalence of atrial arrhythmias. We chose tissue inhibitors of metalloproteinases (TIMPs) and matrix metalloproteinases (MMPs) among others as candidate markers for evaluation based on their previously reported involvement in atrial extracellular matrix remodelling as a substrate for atrial fibrillation.1 The commenting authors raise an important issue by citing clinical studies that have found TIMP-4 to be downregulated in atrial fibrillation (AF),2 whereas we and also others reported increased levels of TIMP-4.1,3 Obvio...
Source: Europace - August 2, 2017 Category: Cardiology Source Type: research

Pulmonary vein re-mapping after cryoballoon ablation for atrial fibrillation
ConclusionPV remapping after CB-PVI revealed residual antral PVP in 4.3% of PVs and in 20% of RIPVs in particular. The Achieve® catheter sometimes fails to detect complete PV antral isolation. (Source: Europace)
Source: Europace - August 1, 2017 Category: Cardiology Source Type: research

First-in-human: leadless Micra transcatheter pacing system meets the Nanostim leadless cardiac pacing system
In March 2017 a 84-year-old patient implanted with a Nanostim [leadless cardiac pacemaker (LCP)] device 3  years ago presented with symptomatic bradycardia (atrial fibrillation, heart rate 40/min) to the emergency department. The Nanostim LCP could not be interrogated due to a battery malfunction. (Source: Europace)
Source: Europace - July 27, 2017 Category: Cardiology Source Type: research

The electrocardiogram as a predictor of successful pharmacological cardioversion and progression of atrial fibrillation
AbstractAimsNon-invasive characterization of atrial fibrillation (AF) substrate complexity based on the electrocardiogram (ECG) may improve outcome prediction in patients receiving rhythm control therapies for AF. Multiple parameters to assess AF complexity and predict treatment outcome have been suggested. A comparative study of the predictive performance of complexity parameters on response to therapy and progression of AF in a large patient population is needed to standardize non-invasive analysis of AF.Methods and resultsA large variety of ECG complexity parameters were systematically compared in patients with recent o...
Source: Europace - July 26, 2017 Category: Cardiology Source Type: research

Pacemaker implantation and mortality: no role as a quality control indicator
I read with interest the article ‘Is mortality a useful parameter for public reporting in pacemaker implantation? Results of an obligatory external quality control programme’ by Nowaket al.1 Cardiac implantable electronic device therapy complication outcome data are an important quality of care indicator for patients and health care systems. Acknowledging complication rates not only improves patient care but in reducing complications cost savings ensue. Death is an important objective outcome frequently included in major adverse cardiovascular event reporting of Primary Percutaneous Coronary Intervention (PPCI)...
Source: Europace - July 25, 2017 Category: Cardiology Source Type: research

Clinical impact, safety, and accuracy of the remotely monitored implantable loop recorder Medtronic Reveal LINQTM
ConclusionThe remote monitoring feature of the Reveal LINQTM allowed earlier diagnosis of asymptomatic but serious arrhythmias in a significant proportion of patients. Implantation of the device outside the EP laboratory appeared safe. However, R-wave undersensing and consequent false recognition of bradyarrhythmias remains a clinically important technical issue. (Source: Europace)
Source: Europace - July 24, 2017 Category: Cardiology Source Type: research

Access to magnetic resonance imaging of patients with magnetic resonance-conditional pacemaker and implantable cardioverter-defibrillator systems: results from the Really ProMRI study
ConclusionIn this study, we reported a 7.0/100 patient-year ’s event rate of MR prescriptions in CIED patients. Many examinations were denied, despite MR-conditional systems, especially in ICD patients. Regulatory and cultural changes are needed to allow wider access to MR imaging in CIED patients with MR-conditional systems. (Source: Europace)
Source: Europace - July 24, 2017 Category: Cardiology Source Type: research

The influence of progression of atrial fibrillation on quality of life: a report from the Euro Heart Survey
AbstractAimsProgression of atrial fibrillation (AF) from paroxysmal to persistent forms is an active field of research. The influence of AF progression on health related quality of life (HRQoL) is currently unknown. We aimed to assess the influence of AF progression on HRQoL, and whether this association is mediated through symptoms, treatment, and major adverse events.Methods and resultsIn the Euro Heart Survey, 967 patients were included with paroxysmal AF who filled out EuroQoL-5D at baseline and at 1  year follow-up. Those who progressed (n = 132, 13.6%) developed more problems during follow-up tha...
Source: Europace - July 19, 2017 Category: Cardiology Source Type: research

Electroanatomical mapping of coronary artery anatomy to guide epicardial ventricular tachycardia ablation
A patient with non-ischaemic dilated cardiomyopathy and recurrent electrical storm was referred for ventricular tachycardia (VT) ablation. An epicardial automated bipolar voltage map was performed using CARTO3-version4TM and aPentarrayTM catheter. A large low-voltage area associated with highly fractionated and late local abnormal ventricular activities (LAVAs) was present in the left ventricle epicardium. (Source: Europace)
Source: Europace - July 19, 2017 Category: Cardiology Source Type: research

Epicardial left atrial appendage AtriClip occlusion reduces the incidence of stroke in patients with atrial fibrillation undergoing cardiac surgery
ConclusionThe long-term results from our first-in-man prospective human trial plus our institutional registry of epicardial LAA occlusion with the AtriClip in patients with AF undergoing cardiac surgery demonstrate the safety and durability of the procedure. In addition, our data are suggestive for the potential efficacy of LAA occlusion in reducing the incidence of stroke. If validated in future large randomized trials, routine LAA occlusion in patients undergoing cardiac surgery (with contraindications to treatment with oral anticoagulants) may represent a reasonable adjunct procedure to reduce the risk of future stroke....
Source: Europace - July 18, 2017 Category: Cardiology Source Type: research

Do women benefit equally as men from the primary prevention implantable cardioverter-defibrillator?
AbstractWomen traditionally have been and are still underrepresented in research in many important areas of cardiology, and guideline recommendations which also encompass women are mostly based on research conducted predominantly in men. However, there is plausible cause to believe that sex may have a potential influence on the benefit derived from the implantable cardioverter-defibrillators (ICD), alone or in association with cardiac resynchronization therapy. We assessed the possible relationship between sex and outcome with ICD implantation in the setting of primary prevention, by pooling the results of MUSTT, MADIT-II,...
Source: Europace - July 18, 2017 Category: Cardiology Source Type: research

Corrigendum
to: Burri H, et al. Left univentricular pacing for cardiac resynchronization therapy [Europace 2017;19:912 –9] (Source: Europace)
Source: Europace - July 18, 2017 Category: Cardiology Source Type: research

Comparison between endocardial and epicardial cardiac resynchronization in an experimental model of non-ischaemic cardiomyopathy
AbstractAimsPacing from the left ventricular (LV) endocardium might increase the likelihood of response to cardiac resynchronization therapy. However, experimental and clinical data supporting this assumption are limited and controversial. The aim of this study was to compare the acute response of biventricular pacing from the LV epicardium and endocardium in a swine non-ischaemic cardiomyopathy (NICM) model of dyssynchrony.Methods and resultsA NICM was induced in six swine by 3  weeks of rapid ventricular pacing. Biventricular stimulation was performed from 16 paired locations in the LV (8 epicardial and 8 endocard...
Source: Europace - July 17, 2017 Category: Cardiology Source Type: research

The second generation cryoballoon has improved durable isolation of left but not right pulmonary veins: new insights from a multicentre study
ConclusionFewer reconnection gaps are observed during redo ablations of paroxysmal AF in patients primarily ablated with CB2. This difference is driven by less reconnection gaps observed in both left PVs, while no difference was observed for right PVs. (Source: Europace)
Source: Europace - July 12, 2017 Category: Cardiology Source Type: research

Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients undergoing elective cardioversion
AbstractAimsNon-vitamin K antagonist oral anticoagulants (NOAC) have been shown to be safe and effective alternatives to warfarin for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF). The aim of this study was to investigate the complications and the use of NOACs in AF patients undergoing elective cardioversion.Methods and resultsThis nationwide multicentre study included consecutive elective cardioversions in AF patients treated with NOACs between October 2011 and May 2016. Data on patient characteristics, antithrombotic treatment and acute (
Source: Europace - July 10, 2017 Category: Cardiology Source Type: research

Response to the ‘Letter to the Editor’ from Madaffari et al. about ‘Reappraisal and new observations on atrial tachycardia ablated from the non-coronary aortic sinus of Valsalva’
[Europace (2017) doi:10.1093/europace/eux078] (Source: Europace)
Source: Europace - July 10, 2017 Category: Cardiology Source Type: research

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)
(Source: Europace)
Source: Europace - July 10, 2017 Category: Cardiology Source Type: research

First description of a Brugada phenocopy in the inferior leads in the context of an acute inferior myocardial infarction
A 67-year-old male patient with no prior medical cardiac history presented to the emergency department with anginal chest pain lasting for 1  h. His electrocardiographic (ECG) revealed ST-segment elevation in leads II, III, and aVF (Figure, A). A diagnosis of acute inferior myocardial infarction was made and the patient was transferred to our Cath Lab for a coronary angiography that revealed right coronary artery (RCA) occlusion in the mid segment and 50% stenosis of the circumflex artery (CX). Personal or family history of unexplained syncope, sudden cardiac death, or implantable cardiac defibrillator implantation ...
Source: Europace - July 10, 2017 Category: Cardiology Source Type: research

Outcomes after catheter ablation and cardioversion in patients with non-valvular atrial fibrillation: results from the prospective, observational XANTUS study
ConclusionSimilar to the results of prospective and non-interventional studies, the low rates of symptomatic thromboembolic events and major bleeding in patients with atrial fibrillation undergoing ablation or cardioversion and treated with rivaroxaban in XANTUS suggest that its use is associated with an acceptable benefit –risk profile in this setting.Trial registration numberClinicaltrials.gov: NCT01606995. (Source: Europace)
Source: Europace - July 7, 2017 Category: Cardiology Source Type: research

Hypothyroidism and congenital long QT: additive effect causing torsades?
A 19-year-old woman was hospitalized following a syncope episode. Initial investigations in the emergency department revealed thyroid-stimulating hormone (TSH; 679 µ/mL; normal 0.35–5.5 µ/mL), free thyroxine (0.36 ng/dL; normal 0.93–1.7 ng/dL), triiodothyronine (23.53 ng/dL; normal 84–202 ng/dL), calcium (9.8 mg/dL), potassium (K; 3.7 mmol/L), and negative urine toxicology. Corrected QT interval (QTc) was noted to be 523 ms on admission e lectrocardiography, and the patient was consequently started on intravenous hydrocortisone and synthroid the...
Source: Europace - July 7, 2017 Category: Cardiology Source Type: research

Combining Watchman left atrial appendage closure and catheter ablation for atrial fibrillation: multicentre registry results of feasibility and safety during implant and 30 days follow-up
ConclusionThe outcomes from these international, multicentre registries support the feasibility and safety of performing combined procedures of ablation and Watchman LAAC for patients with non-valvular AF and high stroke risk. Further data are needed on long-term outcomes for the hybrid technique on all-cause stroke and mortality. (Source: Europace)
Source: Europace - July 3, 2017 Category: Cardiology Source Type: research

The usefulness of right ventriculography to aid anchoring a pacing lead to the right ventricular septum
ConclusionRight ventriculography was very useful in aiding accurate anchoring of the lead to the RVS. Further, pacing from mid-RVS may be more effective in minimizing the QRS duration than pacing from other RVS sites. (Source: Europace)
Source: Europace - June 30, 2017 Category: Cardiology Source Type: research

Tailoring device settings in cardiac resynchronization therapy using electrograms from pacing electrodes
AbstractAimsLeft ventricular (LV) fusion pacing appears to be at least as beneficial as biventricular pacing in cardiac resynchronization therapy (CRT). Optimal LV fusion pacing critically requires adjusting the atrioventricular (AV)-delay to the delay between atrial pacing and intrinsic right ventricular (RV) activation (Ap-RV). We explored the use of electrogram (EGM)-based vectorloop (EGMV) derived from EGMs of implanted pacing leads to achieve optimal LV fusion pacing and to compare it with conventional approaches.Methods and resultsDuring CRT-device implantation, 28 patients were prospectively studied. During atrial-L...
Source: Europace - June 30, 2017 Category: Cardiology Source Type: research

Pacing for hypertrophic obstructive cardiomyopathy: an update and future directions
We describe the mechanisms of action, the prerequisites for successful pacing and provide practical advice on how to optimise therapy. Moreover, the role of the ICD for primary and secondary prevention is discussed with reference to the ESC HCM guidelines. In summary, AV sequential pacing for HOCM is underused in clinical practise despite evidence from two randomised controlled studies. This concept is currently the focus of two randomised studies: a planned randomised controlled study that will compare AV sequential pacing to TASH and an ongoing study that compares CRT to AAI pacing in HOCM patients. In this review we hig...
Source: Europace - June 30, 2017 Category: Cardiology Source Type: research