Safety of beta-blocker discontinuation after acute coronary syndromes with preserved or mildly reduced left ventricular ejection fraction: a target trial emulation from a real-world cohort.

Aims: The benefit of long-term beta-blocker therapy after acute coronary syndromes (ACS) without heart failure in the reperfusion era is uncertain. Two recent randomized trials found conflicting results. The present study assessed the safety of beta-blocker discontinuation within 12 months following ACS with LVEF ≥40%.

Routine beta-blocker therapy after acute coronary syndromes: The end of an era?

Background: Beta-blocker therapy, a treatment burdened by side effects including fatigue, erectile dysfunction and depression, was shown to reduce mortality and cardiovascular events after acute coronary syndromes (ACS) in the pre-coronary reperfusion era. Potential mechanisms include protection from ventricular arrhythmias, increased ischaemia threshold and prevention of left ventricular (LV) adverse remodelling. With the advent of early mechanical reperfusion and contemporary pharmacologic secondary prevention, the benefit of beta-blockers after ACS in the absence of LV dysfunction has been challenged.

Anatomical and Electrophysiological Characteristics of Dual-Loop Re-Entry in Atypical Atrial Flutter: Implications for Mapping and Catheter Ablation.

Atypical atrial flutter (AFL) can be challenging to ablate, especially when involving dual-loop re-entry. We sought to assess the electroanatomical characteristics of single- and dual-loop AFLs in patients undergoing catheter ablation. We analyzed 25 non-cavotricuspid isthmus-dependent macro-re-entrant AFL in 19 consecutive patients.

ATE Score Diagnostic Accuracy for Predicting the Absence of Intra-Atrial Thrombi Before AF Ablation.

Background: In a preliminary study in patients hospitalized for catheter ablation of atrial fibrillation (AF), the atrial thrombus exclusion (ATE) score (stroke, hypertension, heart failure, and D-dimers >270 ng/mL) was developed to rule out the diagnosis of intra-atrial thrombus, with a negative predictive value (NPV) of 100%, and to avoid performing transesophageal echocardiography (TEE).

Objectives: The present study was designed to prospectively confirm the NPV of the ATE score in an independent population.

Methods: Consecutive patients hospitalized for catheter ablation of AF or left atrial tachycardia (LAT) were prospectively enrolled in a multicenter study.

Safety, Efficacy and Prognostic Benefit of Atrial Fibrillation Ablation in Heart Failure with Preserved Ejection Fraction.

Up to 65% of patients with heart failure with preserved ejection fraction (HFpEF) develop AF during the course of the disease. This occurrence is associated with adverse outcomes, including pump failure death. Because AF and HFpEF are mutually reinforcing risk factors, sinus rhythm restoration may represent a disease-modifying intervention.

[Electrocardiographic abnormalities in the setting of acute central nervous system pathology].

Up to 90% of patients with acute central nervous system lesions, such as stroke, exhibit secondary ECG abnormalities, including ST elevation/depression, T wave inversion, prominent U wave, prolonged QTc interval, sinus bradycardia/pause and atrioventricular block. The pathophysiology involves autonomic nervous system disturbance resulting in altered ventricular repolarization gradients, or even myocardial lesions. Clinical assessment aims at distinguishing asymptomatic neurogenic ECG abnormalities from organic heart conditions such as Takotsubo syndrome, myocardial infarction and chronic coronary syndromes.

Recognition of pre-hypertrophic cardiac involvement in Fabry Disease based on automated electrocardiographic measures.

Background: Various electrocardiographic (ECG) indices have been shown to be useful for early recognition and staging of cardiac involvement in Fabry Disease (FD). However, many of them lack acceptable sensitivity and specificity. We assessed the value of automated ECG measures to discriminate between pre-hypertrophic FD and healthy individuals.

Right Atrial Complexity Evolves With Stepwise Left-Sided Persistent Atrial Fibrillation Substrate Ablation and Predicts Outcomes.

Objectives: This study sought to study the relation between outcomes of modified stepwise atrial fibrillation (AF) substrate ablation and dynamic electrogram characteristics in the coronary sinus (CS) and right atrium (RA).

Background: Identifying patients with persistent AF who will benefit from limited lesion sets versus those requiring extensive substrate modification is challenging.

Methods: We studied 70 patients undergoing persistent AF ablation, 43 with acute success (successful ablation [sABL], AF termination, or noninducibility) and 27 with failure (failed ablation [fABL], no termination, or induced AF of >5 minutes).

Significance of post-pacing intervals shorter than tachycardia cycle length for successful catheter ablation of atypical flutter.

Aims: During entrainment mapping of macro-reentrant tachycardias, the time difference (dPPI) between post-pacing interval (PPI) and tachycardia cycle length (TCL) is thought to be a function of the distance of the pacing site to the re-entry circuit and dPPI < 30 ms is considered within the re-entry circuit. This study assessed the importance of PPI < TCL as a successful target for atypical flutter ablation.

Methods And Results: A total of 177 ablation procedures were investigated.

The myocardial phenotype of Fabry disease pre-hypertrophy and pre-detectable storage.

Aims: Cardiac involvement in Fabry disease (FD) occurs prior to left ventricular hypertrophy (LVH) and is characterized by low myocardial native T1 with sphingolipid storage reflected by cardiovascular magnetic resonance (CMR) and electrocardiogram (ECG) changes. We hypothesize that a pre-storage myocardial phenotype might occur even earlier, prior to T1 lowering.

Methods And Results: FD patients and age-, sex-, and heart rate-matched healthy controls underwent same-day ECG with advanced analysis and multiparametric CMR [cines, global longitudinal strain (GLS), T1 and T2 mapping, stress perfusion (myocardial blood flow, MBF), and late gadolinium enhancement (LGE)].

Sustained and self-terminating atrial fibrillation induced immediately after pulmonary vein isolation exhibit differences in coronary sinus electrical activity from onset.

Introduction: Little data exists on the electrophysiological differences between sustained atrial fibrillation (sAF; >5 minutes) vs self-terminating nonsustained AF (nsAF; <5 minutes). We sought to investigate the electrophysiological characteristics of coronary sinus (CS) activity during postpulmonary vein isolation (PVI) sAF vs nsAF.

Methods And Results: We studied 142 patients post-PVI for paroxysmal AF (PAF).

Individualised Approaches for Catheter Ablation of AF: Patient Selection and Procedural Endpoints.

Pulmonary vein isolation (PVI) is the cornerstone of AF ablation, but studies have reported improved efficacy with high rates of repeat procedures. Because of the large interindividual variability in the underlying electrical and anatomical substrate, achieving optimal outcomes requires an individualised approach. This includes optimal candidate selection as well as defined ablation strategies with objective procedure endpoints beyond PVI.

Electrophysiological and Anatomical Correlates of Sites With Postpacing Intervals Shorter Than Tachycardia Cycle Length in Atypical Atrial Flutter.

Background Although entrainment mapping is an established approach to atypical atrial flutter ablation, postpacing intervals shorter than tachycardia cycle length (difference between postpacing interval and tachycardia cycle length [dPPI] <0 ms) remain of unknown significance. We sought to compare anatomic and electrophysiological properties of sites with dPPI <0, dPPI=0-30, and dPPI >30 ms. Methods We studied 24 noncavotricuspid isthmus-dependent macroreentrant atypical atrial flutter in 19 consecutive patients.

Evolution of post-pulmonary vein isolation atrial fibrillation inducibility at redo ablation: Electrophysiological evidence of extra-pulmonary vein substrate progression.

Background: The electrophysiological substrate underlying atrial fibrillation (AF) progression remains difficult to identify.

Objective: The goals of this study were to study the evolution of post-pulmonary vein isolation (PVI) AF inducibility (AFI) after AF ablation and to compare patients with organized atrial tachycardia recurrence (OATr) versus those with paroxysmal or persistent AF recurrence.

Methods: We studied 99 patients who underwent de novo AF ablation (p1) and redo ablation (p2) for AF recurrence (AFr) or OATr.

Intra- and interatrial conduction abnormalities: hemodynamic and arrhythmic significance.

Alterations of normal intra- and interatrial conduction are a common outcome of multiple cardiovascular conditions. They arise most commonly in the context of advanced age, cardiovascular risk factors, organic heart disease, atrial fibrosis, and left atrial enlargement. Interatrial block (IAB), the most frequent and extensively studied atrial conduction disorder, affects up to 20% of the general primary care population.

[ECG : interpretation and clinical significance of P-wave abnormalities].

The ECG provides information about heart rhythm and myocardial integrity, including the atria. The sinus P wave exhibits a 0‑90° axis and a generally biphasic morphology in lead V1. An amplitude >2 mm in lead II and >1 mm in lead V1 is a specific sign of right atrial enlargement, often related to pulmonary disease or pulmonary hypertension.

Recipient Atrial Fibrillation Manifesting as an Irregular Monomorphic Atrial Tachycardia in the Donor Heart.

A 63-year-old man presented with a 1-year history of atrial tachycardia (AT) 6 years after orthotopic heart transplantation with bicaval anastomosis. Twelve-lead electrocardiogram showed monomorphic AT with isoelectric intervals across all leads and strikingly irregular PP intervals. At electrophysiology study, the native left atrium's rhythm was atrial fibrillation (AF) while the donor atria exhibited centrifugal activation of irregular cycle length originating from a site along the left atrial anastomosis.