AFTER-CA: Autonomic Function Transformation and Evaluation Following Catheter Ablation in Atrial Fibrillation.

Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). However, its effects on autonomic function and underlying mechanisms remain poorly understood. This study investigated autonomic and haemodynamic changes following CA and explored their potential implications for patient outcomes.

Prevalence, Management, and Outcomes of Atrial Fibrillation in Paediatric Patients: Insights from a Tertiary Cardiology Centre.

Atrial fibrillation (AF) is increasingly recognised in paediatric patients, presenting unique challenges in management due to its association with various underlying heart conditions. This study aimed to evaluate the prevalence, management strategies, and outcomes of AF in this population. : A retrospective analysis was conducted at a tertiary paediatric cardiology centre, including patients aged ≤18 years diagnosed with AF between January 2015 and December 2023.

Epicardial adipose tissue volume assessed by cardiac CT as a predictor of atrial fibrillation recurrence following catheter ablation.

Introduction: In patients with atrial fibrillation (AF), up to one third have recurrence after a first catheter ablation (CA). Epicardial adipose tissue (EAT) has been considered to be closely related to AF, with a potential role in its recurrence. We aimed to evaluate the association between the volume of EAT measured by cardiac computed tomography (CT) and AF recurrence after CA.

Validation of a Heart Failure Risk Score in a Cohort of Cardiac Resynchronization Therapy Patients Under Remote Monitoring: Results from the TriageHF™ Algorithm.

The heart failure risk status (HFRS) is a validated dynamic tool for risk score prediction, based on the TriageHF™ algorithm (Medtronic, Minneapolis, MN, USA), for the occurrence of a heart failure (HF) event in the 30 days following a remote monitoring (RM) transmission. The aim of this study was to evaluate the accuracy of the HFRS in predicting an unplanned hospital admission due to HF decompensation in a real-world cohort of patients submitted to cardiac resynchronization therapy (CRT). We conducted a single-center review of a cohort of 40 consecutive HF patients, under RM, with CRT devices using the HFRS of the TriageHF™ algorithm.

Evaluation of left atrial strain imaging and integrated backscatter as predictors of recurrence in patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation undergoing catheter ablation.

Background: Impaired left atrial (LA) strain predicts atrial fibrillation (AF) recurrence after catheter ablation (CA), but currently there is no cut-off to guide patient selection for CA. Integrated backscatter (IBS) is a promising tool for noninvasive quantification of myocardial fibrosis. The aim of this study was to compare LA strain and IBS between paroxysmal, persistent, and long-standing persistent AF and evaluate their association with AF recurrence after CA.

Dilated Cardiomyopathy: A Comprehensive Approach to Diagnosis and Risk Stratification.

Dilated cardiomyopathy (DCM) represents one of the most common causes of non-ischemic heart failure, characterised by ventricular dilation alongside systolic dysfunction. Despite advances in therapy, DCM mortality rates remain high, and it is one of the leading causes of heart transplantation. It was recently recognised that many patients present minor structural cardiac abnormalities and express different arrhythmogenic phenotypes before overt heart-failure symptoms.

Quadripolar left ventricle only single lead pacing in a patient with a tricuspid mechanical valve: A less invasive approach.

Unlabelled: In the presence of prosthetic tricuspid valve, the inaccessibility to the right ventricle makes permanent pacing challenging. The placement of a left ventricle (LV) single lead in the coronary sinus (CS) is a well-accepted alternative, with some limitations regarding sensing and threshold. We describe a clinical case of a patient who had a previous LV only lead in the CS due to the presence of a prosthetic tricuspid valve and, after a surgical valvular intervention, presented with recurrent syncope episodes due to lead malfunction with lack of pacing capture and significant ventricular pauses.

Intraventricular gradients-When we have to "exercise" our minds: A case report.

Increased intraventricular pressure gradients due to dynamic left ventricular outflow tract obstruction during exercise have long been known to cause different symptoms. Exercise stress echocardiography is fundamental in the diagnostic approach of symptoms presenting during exercise. We hypothesize on the possible pathophysiological mechanisms responsible for our patient's syncopal episodes.

Remote versus in-office monitoring for implantable cardioverter defibrillators: Results from a randomized pragmatic controlled study in Portugal.

Introduction: Remote monitoring (RM) is a safe and effective alternative to in-office conventional follow-up.

Objective: We aimed to evaluate patient satisfaction with RM and its impact on healthcare resources in a population with cardiac implantable electronic devices.

Methods: Randomized, pragmatic, open-label controlled trial, with adult wearers of implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy with ICD (CRT-D), eligible for the CareLink® system.

The Atrium in Atrial Fibrillation - A Clinical Review on How to Manage Atrial Fibrotic Substrates.

Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and is associated with a significant clinical and economic burden. Rigorous assessment of the presence and degree of an atrial arrhythmic substrate is essential for determining treatment options, predicting long-term success after catheter ablation, and as a substrate critical in the pathophysiology of atrial thrombogenesis. Catheter ablation of AF has developed into an essential rhythm-control strategy.

Lockdown measures for COVID-19 outbreak and variation in physical activity in patients with heart failure and cardiac implantable devices.

Aims: The present study analysed the patterns of physical activity pre-, during and post-lockdown measures for COVID-19 pandemic in patients with chronic heart failure (CHF) and cardiac implantable electronic devices (CIED) under remote monitoring (RM), and assessed the physical activity patterns during these periods.

Methods: The raw data from 95 patients with CHF (age 67,7 15,1 years, 71,5% male) corresponding to 2238 RM transmissions of the Medtronic Carelink™ network platform was obtained. The physical exercise profiles and the impact of the lockdown measures on the physical behaviour during and after the measures were analysed.

Impact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria.

Introduction: There is a lack of consensus on the definition of response to cardiac resynchronization therapy (CRT), and it is not clear which response criteria have most influence on cardiac event-free survival.

Objectives: To assess the predictive value of various response criteria in patients undergoing CRT and the agreement between them.

Methods: We performed a secondary analysis of the BETTER-HF trial.

Prognostic effect and modulation of cardiac sympathetic function in heart failure patients treated with cardiac resynchronization therapy.

Background: Cardiac autonomic dysfunction as assessed by I-metaiodobenzylguanidine (I-mIBG) scintigraphy is associated with poor prognosis in heart failure (HF) patients. Although cardiac resynchronization therapy (CRT) has emerged as an effective therapy in improving outcomes on HF patients, its effect on cardiac sympathetic nervous function is still not fully understood. We aimed to study the value of pre-implantation I-mIBG late heart-to-mediastinum ratio (HMR) as a predictor of response and outcomes after CRT and to correlate modification in this parameter with CRT response and functional improvement.

Response and outcomes of cardiac resynchronization therapy in patients with renal dysfunction.

Purpose: Renal dysfunction is often associated with chronic heart failure, leading to increased morbi-mortality. However, data regarding these patients after cardiac resynchronization therapy (CRT) is sparse. We sought to evaluate response and long-term mortality in patients with heart failure and renal dysfunction and assess renal improvement after CRT.

What happens to non-responders in cardiac resynchronization therapy?

Introduction And Objectives: Left ventricular reverse remodeling (LVRR) is strongly related to the long-term prognosis of patients undergoing cardiac resynchronization therapy (CRT). The aim of this study was to assess the long-term clinical outcome of patients without LVRR at six months after CRT implantation and to determine the prognostic impact of clinical response in this population.

Methods: We analyzed 178 consecutive patients who underwent successful CRT device implantation (age 64±11 years; 69% male; 89% in New York Heart Association [NYHA] functional class III; 35% with ischemic cardiomyopathy).

Relationship of left ventricular global longitudinal strain with cardiac autonomic denervation as assessed by I-mIBG scintigraphy in patients with heart failure with reduced ejection fraction submitted to cardiac resynchronization therapy : Assessment of cardiac autonomic denervation by GLS in patients with heart failure with reduced ejection fraction submitted to CRT.

Background: Heart failure (HF) is associated with cardiac autonomic denervation (AD), which can be non-invasively assessed by I-metaiodobenzylguanidine (I-mIBG) scintigraphy and has prognostic implications. We aimed to study the relationship between myocardial contractility assessed by global longitudinal strain (GLS) and AD assessed by I-mIBG scintigraphy in advanced HF.

Methods/results: BETTER-HF is a prospective randomized clinical trial including HF patients (pts) submitted to cardiac resynchronization therapy (CRT) who are submitted to a clinical, echocardiographic, and scintigraphic assessment before and 6 months after CRT.

[Duration of Atrial Fibrillation Episodes and Implications for the Thromboembolic Risk].

Introduction: Atrial fibrillation is the most common chronic arrhythmia in clinical practice, which is associated with a well known increased thromboembolic risk. The use of oral anticoagulants in this context is well established. However, there are some gaps in information that warrant further studies, such as the duration of an atrial fibrillation event that is long enough to increase the risk of embolic phenomena.

Femoral approach: an exceptional alternative for permanent pacemaker implantation.

The classic transvenous implantation of a permanent pacemaker in a pectoral location may be precluded by obstruction of venous access through the superior vena cava or recent infection at the implant site. When these barriers to the procedure are bilateral and there are also contraindications or technical difficulties to performing a thoracotomy for an epicardial approach, the femoral vein, although rarely used, can be a viable alternative. We describe the case of a patient with occlusion of both subclavian veins and a high risk for mini-thoracotomy or videothoracoscopy, who underwent implantation of a permanent single-chamber pacemaker via the right femoral vein.

[Right atrial aneurysm after chest trauma: late presentation].

We report the case of a 59-year-old patient, with a history of severe chest trauma with rib fractures at the age of 20 and recent onset of fatigue and palpitations, who was diagnosed with atrial tachycardia, which was converted pharmacologically. Cor triatriatum or Ebstein's anomaly were suspected on initial imaging studies (transthoracic echocardiography and MRI). Due to recurrence of arrhythmia, he subsequently underwent repeat echocardiographic evaluation, which established a diagnosis of right atrial aneurysm.

[Incidence of ventricular arrhythmias in patients with severe left ventricular systolic dysfunction: is there a benefit after cardiac resynchronization therapy?].

Background: Cardiac resynchronization therapy (CRT) has significant benefits in selected patients (P). The impact of this modality in the incidence of ventricular tachyarrhythmias remains controversial. We analysed the occurrence of appropriate therapies in P submitted to CRT combined with a cardioverter-defibrillator (ICD).