Utility of Cardiac Magnetic Resonance in Assessing Arrhythmic Risk in Patients With Nonischemic Cardiomyopathy Undergoing Biventricular Pacing.

Background: Nonischemic cardiomyopathy (NICM) is responsible for approximately one-third of heart failure and is associated with significant morbidity and mortality. Recent data suggested the lack of mortality reduction from adding a defibrillator to cardiac resynchronization therapy (CRT) in all patients with NICM. Myocardial fibrosis detected by cardiac magnetic resonance late gadolinium enhancement (CMR-LGE) can help risk stratify patients who would benefit from adding a defibrillator to CRT in this patient population.

FIRE AND ICE: The quest for the perfect modality in atrial fibrillation ablation.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Catheter ablation of atrial fibrillation plays an important role in the management of AF. Radiofrequency ablation is widely used in practice all over the world.

Comparison of Safety and Effectiveness Between Right Versus Left Radial Arterial Access in Primary Percutaneous Coronary Intervention for Acute ST Segment Elevation Myocardial Infarction.

Background: Transradial approach (TRA) is now considered the standard of care in many centres for elective and primary percutaneous intervention (PCI). The use of the radial approach in ST segment elevation myocardial infarction (STEMI) patients has been associated with a significant reduction in major adverse cardiac events. However, it is still unclear if the side of radial access (right vs.

Takotsubo cardiomyopathy: A potentially serious trap (Data from the International Takotsubo Cardiomyopathy Registry).

Takotsubo cardiomyopathy (TTC) is an acute cardiac condition characterized by transient left ventricular dysfunction with wall motion abnormalities, most commonly in the form of apical ballooning. Despite being considered as a generally benign condition, many studies have emphasized potentially sinister outcomes associated with TTC. In this article, we review the most recent results of the International Takotsubo Registry, which investigated the clinical features, prognostic predictors, and outcomes of 1750 patients.

ROCKET AF adds more concerns about Digoxin safety in patients with atrial fibrillation.

In a recent article in the Journal, we have reviewed the adverse cardiovascular outcomes observed with digoxin use in the PALLAS study.(1) The PALLAS study was designed to determine if dronedarone would reduce major vascular events in patients with permanent atrial fibrillation (AF).(2) However the study was stopped early because of safety reasons, as a significant number of patients on the dronedarone arm reached the co-primary end point composite of stroke, myocardial infarction, systemic embolism, or cardiovascular death.

Differential diagnosis at admission between Takotsubo cardiomyopathy and acute apical-anterior myocardial infarction in postmenopausal women.

Background: Takotsubo cardiomyopathy (TTC) typically affects postmenopausal women and clinically presents with chest pain, ST-segment elevation, elevated cardiac enzymes and apical left ventricular (LV) wall motion abnormalities that mimic 'apical-anterior' acute myocardial infarction (AMI). This study assessed whether at-admission clinical evaluation helps in differential diagnosis between the two conditions.

Methods: The study compared at-admission clinical, electrocardiographic (ECG) and echocardiographic findings of 31 women (median age 67 years, interquartile range (IQR) 62-76) with typical TTC and 30 women (median age 73 years, IQR 61-81) with apical-anterior AMI due to acute occlusion of the mid/distal left anterior descending coronary artery.

DECAAF: Emphasizing the importance of MRI in AF ablation.

Atrial fibrillation ablation is a complex and challenging procedure. Appropriate patient selection is the most critical step to ensure safe and successful atrial fibrillation ablation procedure. The DECAAF study (Delayed-Enhancement MRI Determinant of Successful Radiofrequency Catheter Ablation of Atrial Fibrillation) showed that atrial tissue fibrosis, as estimated by delayed enhancement magnetic resonance imaging, was independently associated with recurrent arrhythmia post atrial fibrillation ablation.

Dronedarone-digoxin interaction in PALLAS: A foxglove connection?

In the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS) study, dronedarone use was associated with an excess risk of stroke, cardiovascular death and hospitalizations. However, an increased level in the serum digoxin level was observed in the dronedarone arm, as it is a potent inhibitor of the P-glycoprotein transport system. The PALLAS subanalysis suggests that digoxin-dronedarone interaction was responsible for the higher arrhythmic death rate observed in the trial.

Evolving interpretation of the athlete's electrocardiogram: from European Society of Cardiology and Stanford criteria, to Seattle criteria and beyond.

Electrocardiographic (ECG) pre-participation screening can prevent sudden cardiac death in the athletes by early diagnosis and disqualification of affected individuals. Interpretation of the athlete's ECG should be based on specific criteria, because ECG changes that would be considered abnormal in the untrained population may develop in trained athletes as a physiologic and benign consequence of the heart's adaptation to exercise. In 2010, a stem document from the Section of Sports Cardiology of the European Society of Cardiology (ESC) proposed to classify the athlete's ECG changes according to the prevalence, relation to exercise training, association with an increased risk of cardiovascular disease and need for further investigations into two groups: "common and training-related" (Group 1) and "uncommon and training-unrelated" (Group 2).

The discovery of pulmonary circulation: From Imhotep to William Harvey.

In his quest to comprehend his existence, Man has long been exploring his outer world (macro-cosmos), as well as his inner world (micro-cosmos). In modern times, monmental advances in the fields of physics, chemistry, and other natural sciences have reflected on how we understand the anatomy and physiology of the human body and circulation. Yet, humanity took a long and winding road to reach what we acknowledge today as solid facts of cardiovascular physiology.

STOP-HF: Expanding the role of HF programs into the community.

The St Vincent's Screening TO Prevent Heart Failure (STOP-HF) study is a recently published trial that assessed the use of brain natriuretic peptide (BNP) as a screening tool for HF in an at-risk population in reducing newly-diagnosed heart failure and prevalence of significant left ventricular (LV) systolic and/or diastolic dysfunction. The study provides an excellent model to the global community on how to integrate primary care simple screening with secondary and tertiary level targeted diagnostic and therapeutic system. This integration includes screening of high-risk groups, use of a sensitive screening tool, early diagnostic modalities, early therapeutic interventions, and proper assessment of the hard clinical outcomes.

REVERSE 5-year follow up: CRT impact persists.

The role of cardiac resynchronization therapy (CRT) in patients presenting with mild manifestations of heart failure (HF), depressed left ventricular ejection fraction (LV EF), and wide QRS complex, has been addressed in four previous trials: MIRACLE ICD II,(1) MADIT-CRT,(2) RAFT,(3) and REVERSE.(4) The consistent observed benefits in reverse cardiac remodelling and reduction of heart failure adverse events have resulted in guideline recommendations for CRT in NYHA Class II patients. The guidelines also recommend further studies to determine whether survival is increased by CRT in patients with mild symptoms.

Brugada ECG disclosed by acute malaria: is it all about fever and propofol?

Brugada syndrome is an electrical cardiac disease predisposing to ventricular arrhythmias in which typical electrocardiographic (ECG) features consist of nonischemic repolarization abnormalities in the right precordial leads V1-V3. The appearance of a Brugada-ECG pattern is increasingly observed in critically ill patients and is traditionally attributed to the effect of body temperature and/or drug modulation on cardiac ion channels ("acquired Brugada syndrome"). A patient with complicated malaria in whom Brugada-ECG abnormalities appeared in concomitance with fever and propofol administration is presented.

Exercise-induced normalization of right precordial negative T waves in arrhythmogenic right ventricular cardiomyopathy.

Negative T waves (NTWs) in right precordial leads (V₁ to V₃) may be observed on the electrocardiogram (ECG) of healthy subjects but can also represent the hallmark of an underlying arrhythmogenic right ventricular cardiomyopathy (ARVC). It has been a consistent observation that NTWs usually become upright with exercise in healthy subjects without underlying heart disease. No systematic study has evaluated exercise-induced changes of NTWs in ARVC.