n-3 polyunsaturated fatty acids for the prevention of arrhythmia recurrence after electrical cardioversion of chronic persistent atrial fibrillation: a randomized, double-blind, multicentre study.

Aims: Persistent atrial fibrillation (AF) often recurs after direct current electrical cardioversion (ECV). As several experimental and clinical studies suggest that n-3 polyunsaturated fatty acids (PUFAs) may have antiarrhythmic properties even at the atrial level, we aimed to evaluate whether oral supplementation with PUFAs, in addition to conventional antiarrhythmic drugs, could reduce the recurrence rate of the arrhythmia after ECV of persistent AF.

Methods And Results: Two hundred and four patients (mean age 69.

Upstream effect for atrial fibrillation: still a dilemma?

Atrial fibrillation is the most common arrhythmia in clinical practice. Ion channel blocking agents are often characterized by limited long-term efficacy and several side effects. In addition, ablative invasive procedures are neither easily accessible nor always efficacious.

Early detection of adverse events with daily remote monitoring versus quarterly standard follow-up program in patients with CRT-D.

Background: A relative high rate of clinical and device-related adverse events (AE) is generally reported in patients with implantable defibrillators for cardiac resynchronization therapy (CRT-D). Aim of this study was to compare a daily remote monitoring (RM) to a standard program of in-office visits.

Methods And Results: We retrospectively analyzed RM database and hospital files of 99 CRT-D consecutive patients who were visited in the out-patient clinic every 3-4 months; thirty-three patients were in addition controlled remotely with RM (RM group).

Risk stratification in individuals with the Brugada type 1 ECG pattern without previous cardiac arrest: usefulness of a combined clinical and electrophysiologic approach.

Aims: Risk stratification in individuals with type 1 Brugada electrocardiogram (ECG) pattern (type 1 ECG) for primary prevention of sudden death (SD).

Methods And Results: Three hundred and twenty patients (258 males, median age 43 years) with type 1 ECG were enrolled. No patient had previous cardiac arrest.

[Secondary cardiovascular prevention after acute coronary syndrome in clinical practice].

Secondary prevention after acute coronary syndromes should be aimed at reducing the risk of further adverse cardiovascular events, thereby improving quality of life, and lengthening survival. Despite compelling evidence from large randomized controlled trials, secondary prevention is not fully implemented in most cases after hospitalization for acute coronary syndrome. The Lazio Region (Italy) has about 5.

How many atrial fibrillation ablation candidates have an underlying supraventricular tachycardia previously unknown? Efficacy of isolated triggering arrhythmia ablation.

Aims: Supraventricular tachycardia may trigger atrial fibrillation (AF). The aim of the study was to evaluate the prevalence of supraventricular tachycardia (SVT) inducibility in patients referred for AF ablation and to evaluate the effects of SVT ablation on AF recurrences.

Methods And Results: Two hundred and fifty-seven patients (185 males; mean age: 53.

Efficacy of ivabradine administration in patients affected by inappropriate sinus tachycardia.

Background: Inappropriate sinus tachycardia (IST) is characterized by an elevated heart rate (HR) at rest and an exaggerated HR response to physical activity or emotional stress. Beta-blockers and calcium channel blockers are the first-line therapy but sometimes are poorly tolerated due to side effects.

Objective: The purpose of this study was to evaluate the efficacy and safety of ivabradine, a selective inhibitor of the I(f) current of the sinoatrial node, in patients affected by IST.

A randomized double-blind comparison of biventricular versus left ventricular stimulation for cardiac resynchronization therapy: the Biventricular versus Left Univentricular Pacing with ICD Back-up in Heart Failure Patients (B-LEFT HF) trial.

Background: Biventricular (BiV) stimulation is the preferred means of delivering cardiac resynchronization therapy (CRT), although left ventricular (LV)-only stimulation might be as safe and effective. B-LEFT HF is a prospective, multicenter, randomized, double-blind study aimed to examine whether LV-only is noninferior to BiV pacing regarding clinical and echocardiographic responses.

Methods: B-LEFT HF randomly assigned 176 CRT-D recipients, in New York Heart Association class III or IV, with an LV ejection fraction < or =35% and QRS > or =130 milliseconds, to a BiV (n = 90) versus LV (n = 86) stimulation group.

Efficacy of ivabradine in a case of inappropriate sinus tachycardia and ventricular dysfunction.

We present a case of a 49-year-old man with inappropriate sinus tachycardia and ventricular dysfunction. The conventional treatment (ace-inhibitor and beta-blockers) was not well tolerated by the patient, so Ivabradine, a specific inhibitor of If current in the sinus node, was started. After 3 months of using this medication, we observed an improvement of ejection fraction and quality of life.

Risk of arrhythmias in myotonic dystrophy: trial design of the RAMYD study.

Objective: Myotonic dystrophy type 1 (DM1) is the most frequent muscular dystrophy in adults. DM1 is a multisystem disorder also affecting the heart with an increased incidence of sudden death, which has been explained with the common impairment of the conduction system often requiring pacemaker implantation; however, the occurrence of sudden death despite pacemaker implantation and the observation of major ventricular arrhythmias generated the hypothesis that ventricular arrhythmias may play a causal role as well. The aim of the study was to assess the 2-year cumulative incidence and the value of noninvasive and invasive findings as predictive factors for sudden death, resuscitated cardiac arrest, ventricular fibrillation, sustained ventricular tachycardia and severe sinus dysfunction or high-degree atrioventricular block.

Product-experience reporting on endocardial defibrillation leads: a 4-year national perspective.

The medical device industry must implement accurate programs to monitor product performance once the product is released into the market. Product-experience reports provide a means for physicians who use medical devices to provide continuous feedback to manufacturers in order to monitor device performance. We examined product-experience reports sent from Italy over 4 years (2004-2007) related to a single manufacturer's family of permanent endocardial leads (Endotak Reliance, Boston Scientific, MA, USA) used with implantable cardioverter-defibrillators.

Use of electroanatomic mapping in the assessment of atrial tachycardia aetiology.

The present case report is of a 36-year-old man who had been symptomatic for frequent palpitations for 4 years after a prolonged febrile episode. The electrocardiogram on admission revealed an iterative supraventricular tachycardia at rate of 110 bpm, with ventriculoatrial interval of 180 ms and superior P-wave axis. Electroanatomic mapping showed substantially normal values in the right atrium other than an area along the posteroseptal region of the tricuspid annulus, with a low-voltage region that correlated with the area of earliest activation.

Cardiomyopathy induced by adenosine-insensitive atrial tachycardia.

Tachycardia-induced cardiomyopathy may be provoked by several arrhythmias; it may reverse following stable restoration of sinus rhythm. We report the case of a 33-year-old man who was diagnosed to have a dilated cardiomyopathy. Over a few months, the cardiomyopathy reversed.

Diagnostic accuracy of a new software for complex fractionated electrograms identification in patients with persistent and permanent atrial fibrillation.

Introduction: The elimination of complex fractionated atrial electrograms (CFAEs) has been proposed as a potential target for guiding successful AF substrate ablation. The possibility to efficiently map the atria and rapidly identify CFAEs sites is necessary, before the CFAEs ablation becomes a routine approach. The aims of this study, conducted in patients with persistent and permanent atrial fibrillation (AF), were to analyze by CARTO mapping in the right (RA) and in the left atrium (LA) during AF: (1) the diagnostic accuracy of a new software for CFAEs analysis, (2) the spatial distribution of CFAEs, (3) the regional beat to beat AF intervals (FF).

Successful catheter ablation of a manifest left anterior accessory pathway.

Left anterior accessory pathways are considered to be rare. The junction between the mitral and aortic valves consists of a continuous fibrous tissue. Nevertheless, muscular pathways connecting the left atrial and ventricular myocardium through the fibrous ring between these valves have been observed very rarely.

Catheter ablation of isolated premature ventricular contractions arising from the sinus of Valsalva.

Monomorphic premature ventricular contractions (PVCs) are a benign phenomenon in patients without structural heart disease. The focal source is usually localised in the right ventricular outflow tract and more rarely in the left ventricular outflow tract. We report two cases of frequent isolated PVCs treated with radiofrequency catheter ablation.

Relation of C-reactive protein to long-term risk of recurrence of atrial fibrillation after electrical cardioversion.

The aim of this study is to assess the role of C-reactive protein (CRP) in predicting long-term risk of atrial fibrillation (AF) recurrence after electrical cardioversion. CRP levels are associated with the presence of AF and failure of electrical or pharmacologic cardioversion, but no previous study has assessed their predictive role in long-term follow-up after successful electrical cardioversion. One hundred two consecutive patients (age 67 +/- 11 years; 58 men) with nonvalvular persistent AF who underwent successful biphasic electrical cardioversion were studied.

Tachycardia-induced cardiomyopathy: mechanisms of heart failure and clinical implications.

The prognosis of dilated cardiomyopathy is generally poor. The cause of ventricular dysfunction often cannot be identified. In most cases, the clinical history of cardiomyopathy is irreversible but, in some cases, potentially curable causes may be identified.

Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: a prospective and randomized study.

Objectives: The aim of this study was to compare--in patients with persistent and permanent atrial fibrillation (AF)--the efficacy and safety of left atrial ablation with that of a biatrial approach.

Background: Left atrium-based catheter ablation of AF, although very effective in the paroxysmal form of the arrhythmia, has an insufficient efficacy in patients with persistent and permanent AF.

Methods: Eighty highly symptomatic patients (age, 58.

Recovery of cardiac function after ablation of atrial tachycardia arising from the tricuspid annulus.

Tachycardia-induced cardiomyopathy is a reversible form of heart failure. An early diagnosis and an effective cure of the underlying tachycardia are crucial for a favorable outcome. Different kinds of atrial and ventricular arrhythmias may induce tachycardiomyopathy.

Atrial flutter and atrial fibrillation: which relationship? New insights into the electrophysiological mechanisms and catheter ablation treatment.

Atrial fibrillation (AF) and atrial flutter (AFL) are two arrhythmias commonly associated in clinical practice. This association generally reflects a similar arrhythmogenic substrate. It has been observed that the development of isthmus-dependent AFL is often preceded by AF.

N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial.

Objectives: The aim of this study was to assess the efficacy of preoperative and postoperative treatment with n-3 polyunsaturated fatty acids (PUFAs) in preventing the occurrence of atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG).

Background: Postoperative AF is a common complication of CABG. There is growing clinical evidence that PUFAs have cardiac antiarrhythmic effects.

Short QT syndrome: pharmacological treatment.

Objectives: The purpose of this study was to evaluate the efficacy of various antiarrhythmic drugs at prolonging the QT interval into the normal range and preventing ventricular arrhythmias in patients with short QT syndrome.

Background: Short QT syndrome is a recently described genetic disease characterized by short QT interval, high risk of sudden death, atrial fibrillation, and short refractory periods.

Methods: Six patients with short QT syndrome, five of whom had received an implantable cardioverter-defibrillator (ICD) and one child, were tested with different antiarrhythmic drugs, including flecainide, sotalol, ibutilide, and hydroquinidine, to determine whether they could prolong the QT interval into the normal range and thus prevent symptoms and arrhythmia recurrences.

Long-term follow-up of right atrial ablation in patients with atrial fibrillation:

Introduction: The aim of this study was to evaluate the efficacy and the impact on quality of life of a new ablative approach to the right atrium in patients with atrial fibrillation (AF).

Methods And Results: Seventy-four symptomatic patients with paroxysmal (n = 49) or permanent (n = 25) refractory AF underwent radiofrequency ablation. A nonfluoroscopic electroanatomic mapping system was used to perform the following lesions: (1) an isthmus line between the tricuspid annulus and the inferior vena cava; (2) a posterior intercaval line from the superior vena cava and the inferior vena cava; (3) a septal line from the superior vena cava to the fossa ovalis, proceeding to the coronary sinus ostium where a circumferential line around the ostium was performed, and then on to the inferior vena cava; and (4) a transversal lesion connecting the posterior intercaval and the septal lesions.