Publications by authors named "Konstantinos P Letsas"

Approximately 10 % of patients who have suffered from myocardial infarction develop new-onset atrial fibrillation (AF). Coronary artery disease implicating atrial branches has been associated with AF. The following variables have been associated with new-onset AF in the setting of acute coronary syndrome: older age, history of hypertension, history of angina, history of stroke, chronic renal failure, body mass index, no statin use, worse nutritional status, worse Killip class, admission heart rate ≥ 85 bpm, complete atrioventricular block, Glasgow prognostic score, Syntax score, CHEST score > 3, PRECISE-DAPT score ≥ 25, left ventricular ejection fraction ≤40 %, increased left atrial diameter, E/E' ratio > 12, epicardial fat tissue thickness, and thrombolysis in myocardial infarction flow <3.

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Introduction: Pulsed field ablation (PFA) is a form of nonthermal energy that has been recently introduced for pulmonary vein isolation (PVI). A multi-electrode pentaspline catheter for delivery of PFA guided by fluoroscopy has become widely available for clinical use.

Methods And Results: In this study, we aimed to assess whether the addition of electroanatomical mapping (EAM) for confirmation of PVI in the acute phase can increase the efficacy of the procedure in terms of arrhythmia recurrences.

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Article Synopsis
  • A novel lattice-tip catheter designed for high-density mapping and dual ablation was studied for its effectiveness in diagnosing and treating atrial tachycardias (ATs).
  • The study involved 20 patients, where activation mapping accurately identified AT mechanisms, and successful conversion to sinus rhythm was achieved in most cases without major complications.
  • The results suggest that this catheter provides effective mapping and ablation for ATs, but certain limitations need to be recognized.
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Aims: The left bundle branch block (LBBB) is a strong predictor of response to cardiac resynchronization therapy (CRT). However, a significant number of patients do not respond to the treatment. The study sought to evaluate the impact of the stricter Strauss criteria for left bundle branch block (St-LBBB) on CRT response, hospitalizations, ventricular arrhythmia (VA) events and mortality.

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Article Synopsis
  • Atrial fibrillation (AF) is the most common arrhythmia after surgery, and this study aimed to find out how often it occurs (postoperative AF or POAF) and what factors predict it, especially focusing on inflammation markers like C-reactive protein (CRP).
  • In a study with over 53,000 patients, POAF happened in 570 patients (1.1%), primarily occurring around 3.4 days post-surgery, with a notable link between higher CRP levels and the likelihood of developing POAF.
  • The research found that patients undergoing lung and cardiovascular surgeries had the highest risk of POAF, indicating that surgery type and levels of inflammation are key predictors of this condition.
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Objective: This study aimed to explore the impact of a combination of hyperuricemia (HUA) and excessive high-sensitivity C-reactive protein (hs-CRP) levels on the likelihood of developing cardiac conduction block (CCB). Additionally, it sought to assess whether the influence of uric acid (UA) on CCB is mediated by hs-CRP.

Methods: A prospective study was executed utilizing data from the Kailuan cohort, including 81,896 individuals initially free from CCB.

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Background: Left atrial (LA) fibrosis has been shown to be associated with atrial fibrillation (AF) recurrence. Beat-to-beat (B2B) index is a non-invasive classifier, based on B2B P-wave morphological and wavelet analysis, shown to be associated with AF incidence and recurrence. In this study, we tested the hypothesis that the B2B index is associated with the extent of LA low-voltage areas (LVAs) on electroanatomical mapping.

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Article Synopsis
  • * Follow-up over approximately 29 months revealed that ILRs helped establish diagnoses in significant portions of these patients, particularly detecting issues like atrial fibrillation in those with a history of cryptogenic stroke.
  • * The findings suggest that ILRs not only aid in diagnosis but also lead to changes in treatment strategies for around one-fourth of the patients, making them a valuable tool in cardiac evaluations.
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Background: Long-term data showed that up to 27% of pulmonary veins are reconnected using cryoballoon ablation. This study aimed to evaluate the efficacy of the latest 4th-generation cryoballoon catheters using ultra high-resolution mapping.

Methods: In patients with atrial fibrillation, a standard pulmonary vein isolation (PVI) with the latest 4th-generation cryoballoon catheter (Arctic Front Advance PRO, Medtronic Minneapolis, USA) and the spiral mapping catheter (Achieve Advance, Medtronic, Minneapolis, MN, USA) was performed.

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Background: Atrial fibrillation (AF), the most common arrhythmia, is closely related to inflammation. Colchicine has the potent anti-inflammatory effects. Several randomized clinical trials (RCTs) have evaluated the efficacy and safety of colchicine in the prevention of AF but the results are inconsistent.

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Cardiac amyloidosis (CA) is related to the aggregation of insoluble fibrous deposits of misfolded proteins within the myocardium. Transthyretin amyloidosis (ATTR) and immunoglobulin light-chain amyloidosis are the main forms of CA. Atrial fibrillation (AF) is a common arrhythmia in CA patients, especially in those with ATTR amyloidosis.

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Background: High-power short-duration (HPSD) and very-high-power short-duration (vHPSD-90 W/4 s) radiofrequency (RF) technology has reduced the procedure time of pulmonary vein isolation (PVI) using RF without compromising the efficacy of the technique. The current study compares the novel technology of HPSD/vHPSD with cryoablation (CRYO) in terms of efficacy, safety, and procedure time in a cohort of symptomatic patients with paroxysmal atrial fibrillation (pAF).

Methods: This is a prospective, non-randomized trial.

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Experimental in vivo and in vitro studies showed that electric currents applied during the absolute refractory period can modulate cardiac contractility. In preclinical studies, cardiac contractility modulation (CCM) was found to improve calcium handling, reverse the foetal myocyte gene programming associated with heart failure (HF), and facilitate reverse remodeling. Randomized control trials and observational studies have provided evidence about the safety and efficacy of CCM in patients with HF.

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Key Clinical Message: R-wave double counting is a rare cause of ventricular oversensing that can lead to inappropriate shocks. Optimizing device programming is essential for the avoidance of subsequent inappropriate therapies.

Abstract: R-wave double counting is a rare cause of ventricular oversensing that can lead to inappropriate shocks.

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Risk stratification of patients with Brugada syndrome (BrS) remains challenging. Signal-averaged electrocardiogram (SAECG) is a noninvasive tool that can be used to identify the electrophysiologic substrate potentially underlying fatal ventricular arrhythmias. The aim of this meta-analysis is to summarize the existing evidence about the role of late potentials (LP) as a predictor for arrhythmic events in patients with BrS.

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Article Synopsis
  • Patients with end-stage heart failure often experience increased ventricular arrhythmias that negatively impact heart function and lead to hospitalizations.
  • While implantable cardioverter-defibrillators can stop dangerous arrhythmias, they don't reduce the overall frequency of these episodes.
  • Effective management usually involves a combination of invasive and noninvasive treatments, with this review highlighting recent advancements in catheter ablation and a structured treatment approach.
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Cardioneuroablation is an emerging alternative therapeutic modality for young patients with severe neurally-mediated syncope. We present two images of cardioneuroablation performed in young patients who suffered from recurrent neurally-mediated syncope with asystole and functional atrioventricular block. The patients remain syncope-free during follow-ups.

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Background: Balloon pulmonary angioplasty (BPA) has provided an effective invasive treatment for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The hemodynamic improvement achieved by BPA has significantly increased the long-term prognosis of these patients, mostly by reversing the negative remodeling of the right ventricle (RV).

Materials And Methods: In a cohort of 17 patients with symptomatic CTEPH hemodynamic data were collected before and after the completion of BPA sessions.

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Background: Health care resource utilization (HCRU) and costs are important metrics of health care burden, but they have rarely been explored in the setting of cardiac ion channelopathies.

Hypothesis: This study tested the hypothesis that attendance-related HCRUs and costs differed between patients with Brugada syndrome (BrS) and congenital long QT syndrome (LQTS).

Methods: This was a retrospective cohort study of consecutive BrS and LQTS patients at public hospitals or clinics in Hong Kong, China.

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Mitral valve prolapse (MVP) has an estimated prevalence of 2-3% in the general population. Patients with MVP have an increased risk of ventricular arrhythmic events. The aim of this meta-analysis was to identify easily obtained markers that can be used for the arrhythmic risk stratification of MVP patients.

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Introduction: Patients with persistent atrial fibrillation (AF) represent a challenging population for rhythm control therapies. Catheter ablation (CA) with pulmonary vein isolation (PVI) is an effective treatment option for the reduction of the arrhythmic burden. Data regarding the comparability between radiofrequency (RF) and cryoballoon ablation (CRYO) in persistent AF are limited.

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We present a case of a previously healthy 23-year-old male who presented with chest pain, palpitations and spontaneous type 1 Brugada electrocardiographic (ECG) pattern. Positive family history for sudden cardiac death (SCD) was remarkable. Initially, clinical symptoms in combination with myocardial enzymes elevation, regional myocardial oedema with late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and inflammatory lymphocytoid-cell infiltrates in the endomyocardial biopsy (EMB) suggested the diagnosis of a myocarditis-induced Brugada phenocopy (BrP).

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Article Synopsis
  • Brugada syndrome (BrS) is a serious heart condition linked to sudden cardiac death, but the effectiveness of electrophysiological studies (EPS) for assessing risk in asymptomatic patients is debated.
  • This study analyzed data from 19 research studies involving over 6200 BrS patients to evaluate the correlation between positive EPS results and subsequent arrhythmic events.
  • The findings suggest that a positive EPS significantly predicts future arrhythmic events in BrS patients, reinforcing the utility of EPS as a method for identifying individuals who may benefit from preventative measures like implantable cardioverter-defibrillators (ICDs).
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