Prevalence and progression of LV dysfunction and dyssynchrony in patients with new-onset LBBB post TAVR.

Background: The impact of new-onset left bundle branch block (N-LBBB) developing after Transcatheter Aortic Valve Replacement (TAVR) on cardiac function and mechanical dyssynchrony is not well defined.

Methods: We retrospectively screened all patients who underwent TAVR in our centre between Oct 2018 and Sept 2021 (n = 409). We identified 38 patients with N-LBBB post-operatively (of which 28 were persistent and 10 were transient), and 17 patients with chronic pre-existent LBBB (C-LBBB).

Combined Area of Left and Right Atria May Outperform Atrial Volumes as a Predictor of Recurrences after Ablation in Patients with Persistent Atrial Fibrillation-A Pilot Study.

: Left atrial (LA) remodelling and dilatation predicts atrial fibrillation (AF) recurrences after catheter ablation. However, whether right atrial (RA) remodelling and dilatation predicts AF recurrences after ablation has not been fully evaluated. : This is an observational study of 85 consecutive patients (aged 57 ± 9 years; 70 [82%] men) who underwent cardiac magnetic resonance before first catheter ablation for AF (40 [47.

Hypersensitivity Reactions to Components of Cardiac Implantable Electronic Devices and Their Treatment: A Systematic Review.

Hypersensitivity reactions (HSRs) to components of cardiac implantable electronic devices (CIEDs) are rare but difficult to differentiate from device infection. Data on best management strategies of HSRs to CIEDs are lacking. The aims of this systematic review are to summarise the available literature on the aetiology, diagnosis and management of HSR in CIED patients and to provide guidance on best management strategies for these patients.

An Unusual Cause of Cerebral Embolism: PFO-Straddling, Spontaneously Fractured Pacemaker Lead.

We report an exceptionally rare complication of cardiac pacing: a case of spontaneous fracture of a modern bipolar pacing lead that led to migration across a patent foramen ovale into the left atrium and embolic stroke. ().

ST elevation myocardial infarction, or not - This is the question.

We present an artefactual ECG created by a digital ECG-recording machine, caused by deletion of the first 80 ms of the QRS complex immediately following the pacing spike in a patient with complete atrio-ventricular block, biventricular pacing and chronic atrial fibrillation. The artefact was mistaken for inferior ST elevation myocardial infarction and the patient underwent unnecessary urgent coronary angiogram. We are not aware of this particular artefact pattern being previously reported in the literature.

A regularly irregular tachycardia with variable QRS morphologies - What is the mechanism?

We present a complex ECG displaying a combination of atrial tachycardia with Mobitz type I AV block, and right bundle branch block (RBBB) alternans (RBBB alternating with normal QRS conduction) during Wenckebach cycle. A detailed explanation regarding the mechanism of this complex arrhythmia is provided, and the mechanism of bundle branch alternans is reviewed. A unique feature of our case is the added complexity given by the presence of atrial tachycardia and AV Wenckebach, which departs from the previous description of bundle branch alternans during 1:1 AV conduction.

Reproducibility of Combined Acquisition and Measurement of Left Ventricular Longitudinal Peak Segmental Strain in Relation to the Severity of Left Ventricular Dysfunction.

Background: Whether left ventricular (LV) longitudinal peak systolic segmental strain (LPSS) has sufficient reproducibility to be used in clinical practice (e.g., in patient follow-up) remains unclear.

ST elevation in a patient with small bowel occlusion and gastric distension-What is the most likely explanation? A hypothesis generating case report.

We report a case of ST segment elevation and PR depression in inferolateral leads in a patient with small bowel occlusion and gastric distension that disappeared immediately after gastric evacuation. Contrary to prior reports, we believe that these ECG changes do not represent an intrinsic cardiac electrical abnormality, but are likely artefactual. We hypothesise that the accumulated air between the heart, lower limbs and left precordial electrodes result in a significant departure from the simplified assumptions of standard 12 lead ECG analysis (that the electrical activity of the heart can be described by an electrical dipole at a fixed location in an electrical homogeneous sphere) in such a way that the ECG filtering process will not compensate for this bias and will artificially create the ECG pattern described in this report.

A Review of Driving Restrictions in Patients at Risk of Syncope and Cardiac Arrhythmias Associated with Sudden Incapacity: Differing Global Approaches to Regulation and Risk.

The ability to drive is a highly valued freedom in the developed world. Sudden incapacitation while driving can result in injury or death for the driver and passengers or bystanders. Cardiovascular conditions are a primary cause for sudden incapacitation and regulations have long existed to restrict driving for patients with cardiac conditions at high risk of sudden incapacitation.

Reproducibility and accuracy of late gadolinium enhancement cardiac magnetic resonance measurements for the detection of left atrial fibrosis in patients undergoing atrial fibrillation ablation procedures.

Aims: Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) may define left atrial (LA) anatomy and structural remodelling, and facilitate atrial fibrillation (AF) ablation. We aimed to assess the intra- and inter-observer reproducibility and agreement of LGE-CMR parameters with direct application to AF ablation techniques.

Methods And Results: One experienced and one non-experienced observer performed complete LGE-CMR data analysis twice, on different days, in 40 randomly selected LGE-CMR examinations [20 performed before ablation (pre-ablation) and 20 performed 3 months after ablation (post-ablation)].

Postprocedural LGE-CMR comparison of laser and radiofrequency ablation lesions after pulmonary vein isolation.

Introduction: The purpose of this study was to compare the anatomical characteristics of scar formation achieved by visual-guided laser balloon (Laser) and radiofrequency (RF) pulmonary vein isolation (PVI), using late-gadolinium-enhanced cardiac magnetic resonance imaging (LGE-CMR).

Methods And Results: We included 17 patients with paroxysmal or early persistent drug resistant AF who underwent Laser ablation; 2 were excluded due to procedure-related complications. The sample was matched with a historical group of 15 patients who underwent PVI using RF.

Persistent atrial fibrillation vs paroxysmal atrial fibrillation: differences in management.

Atrial fibrillation (AF) is the most common human arrhythmia. AF is a progressive disease, initially being nonsustained and induced by trigger activity, and progressing towards persistent AF through alteration of the atrial myocardial substrate. Treatment of AF aims to decrease the risk of stroke and improve the quality of life, by preventing recurrences (rhythm control) or controlling the heart rate during AF (rate control).

Assessment of aortic valve disease - a clinician oriented review.

Aortic valve disease [aortic stenosis (AS) and aortic regurgitation (AR)] represents an important global health problem; when severe, aortic valve disease carries poor prognosis. For AS, aortic valve replacement, either surgical or interventional, may provide definite treatment in carefully selected patients. For AR, valve surgery (either replacement or - in selected cases - aortic valve repair) remains the gold standard of care.

Clinical outcomes in patients with atrial fibrillation according to sex during anticoagulation with apixaban or warfarin: a secondary analysis of a randomized controlled trial.

Aim: To assess clinical outcomes, efficacy, and safety according to sex during anticoagulation with apixaban compared with warfarin in patients with atrial fibrillation.

Methods And Results: Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) was a randomized, double-blind, placebo-controlled, multicentre trial that included 11 785 (64.7%) men and 6416 (35.

Do left atrial strain and strain rate reflect intrinsic atrial function, or are they determined by left ventricular function?

Background: Left atrial (LA) strain (S) and strain rate (SR) are reported as measures of intrinsic function.

Aim: Since the LA and left ventricle (LV) are connected through the mitral annulus, we investigated: (1) if deformation indices in the LA are mostly predicted by deformation of the LV; (2) if timings of S and SR events are similar in both the LA and LV; and (3) if alteration of S and SR in patients with primarily LV dysfunction would be similar in the LA and LV.

Methods: We retrospectively assessed 50 asymptomatic women (Group 1) and 20 patients with recent (< 96 h) acute pulmonary oedema (10 women) (Group 2).