The Prognostic Role of Global Longitudinal Strain and NT-proBNP in Heart Failure Patients Receiving Cardiac Resynchronization Therapy.

Background: We aimed to evaluate whether baseline GLS (global longitudinal strain), NT-proBNP, and changes in these after cardiac resynchronization therapy (CRT) can predict long-term clinical outcomes and the echocardiographic-based response to CRT (defined by 15% relative reduction in left ventricular end-systolic volume).

Methods: We enrolled 143 patients with stable ischemic heart failure (HF) undergoing CRT-D implantation. NT-proBNP and echocardiography were obtained before and 6 months after.

Clinical performance of implantable cardioverter-defibrillator lead monitoring diagnostics.

Background: Implantable cardioverter-defibrillator (ICD) lead monitoring diagnostic alerts facilitate the diagnosis of structural lead failure.

Objective: The purpose of this study was to prospectively study the performance of Medtronic ICD lead monitoring alerts.

Methods: A prespecified ancillary substudy, World-Wide Randomized Antibiotic Envelope Infection Prevention Trial, was conducted in patients with an ICD with all available alerts enabled.

The value of remote care in the reduction of healthcare utilization in implantable cardioverter-defibrillator patients.

Background: Minimal evidence is available of the reduction in healthcare utilization of remote care in ICD patients over a longer period of follow-up.

Objectives: This study compared healthcare utilization up to 3 year follow-up in implantable cardioverter-defibrillator (ICD) patients with remote care compared to conventional care.

Methods: We conducted a retrospective cohort study of patients who received a single or dual-chamber ICD or cardiac resynchronization therapy-defibrillator (CRT-D) between 2016 and 2018.

Dabigatran trough concentrations in very elderly patients.

Objectives: The aim of this observational study was to explore dabigatran concentrations in elderly and very elderly patients in a real-life population. Patients aged >75 years receiving dabigatran have a significantly higher risk of gastrointestinal bleeding compared withthose receiving warfarin. High trough concentrations have an important impact on this bleeding risk.

Improving clinical outcomes and patient satisfaction among patients with coronary artery disease: an example of enhancing regional integration between a cardiac centre and a referring hospital.

Background: Value-based healthcare (VBHC) is a promising strategy to increase patient value. For a successful implementation of VBHC, intensive collaborations between organizations and integrated care delivery systems are key conditions. Our aim was to evaluate the effects of a pilot study regarding enhancing regional integration between a cardiac centre and a referring hospital on patient-relevant clinical outcomes and patient satisfaction.

Performance of idarucizumab as antidote of dabigatran in daily clinical practice.

Aims: Because practice-based data on the usage of idarucizumab for urgent dabigatran reversal is unavailable, we evaluated the appropriateness of idarucizumab usage, its haemostatic effectiveness and clinical outcomes.

Methods And Results: An observational cohort study was performed including consecutive patients who were treated with idarucizumab between 2016 and 2018. Appropriate usage was assessed with predefined criteria.

Influenza infection and heart failure-vaccination may change heart failure prognosis?

The interaction of influenza infection with the pathogenesis of acute heart failure (AHF) and the worsening of chronic heart failure (CHF) is rather complex. The deleterious effects of influenza infection on AHF/CHF can be attenuated by specific immunization. Our review aimed to summarize the efficacy, effectiveness, safety, and dosage of anti-influenza vaccination in HF.

Spatial distribution of electrical reconnection after pulmonary vein isolation in patients with recurrent paroxysmal atrial fibrillation.

Introduction: Recurrence of atrial fibrillation after pulmonary vein isolation (PVI) occurs frequently and may be associated with electrical reconnection of the pulmonary veins (PV). We investigated spatial distribution of electrical reconnection during re-do procedures in patients with paroxysmal atrial fibrillation who had previous successful acute electrical PVI with either single irrigated tip, antral ablation (s-RF; n = 38) or multi-electrode, duty-cycled ablation (PVAC; n = 48).

Methods And Results: EP navigator, mapping and irrigated tip ablation catheters were used in all re-do procedures.

Multielectrode Pulmonary Vein Isolation Versus Single Tip Wide Area Catheter Ablation for Paroxysmal Atrial Fibrillation: A Multinational Multicenter Randomized Clinical Trial.

Background: Single-shot ablation techniques may facilitate safe and simple pulmonary vein isolation to treat paroxysmal atrial fibrillation. Multielectrode pulmonary vein isolation versus single tip wide area catheter ablation-paroxysmal atrial fibrillation is the first multinational, multicenter, prospective, noninferiority randomized clinical trial comparing multielectrode-phased radiofrequency ablation (MEA) to standard focal irrigated radiofrequency ablation (STA) using 3-dimensional navigation.

Methods And Results: Patients with paroxysmal atrial fibrillation were randomized to MEA (61 patients) or STA (59 patients).

Early performance of a miniaturized leadless cardiac pacemaker: the Micra Transcatheter Pacing Study.

Aims: Permanent cardiac pacing is the only effective treatment for symptomatic bradycardia, but complications associated with conventional transvenous pacing systems are commonly related to the pacing lead and pocket. We describe the early performance of a novel self-contained miniaturized pacemaker.

Methods And Results: Patients having Class I or II indication for VVI pacing underwent implantation of a Micra transcatheter pacing system, from the femoral vein and fixated in the right ventricle using four protractible nitinol tines.

[The implantable cardiac defibrillator: indications and complications].

The implantation of an implantable cardiac defibrillator (ICD) is indicated as a secondary prevention measure for sudden cardiac death in patients surviving a life-threatening ventricular arrhythmia that had no reversible or treatable cause. An ICD is indicated as a primary prevention measure for sudden cardiac death in patients with a left-ventricular ejection fraction (LVEF) ≤ 35%. A biventricular ICD is indicated in patients with heart failure class ≥ II according to the New York Heart Association classification, a widened QRS complex and an LVEF ≤ 35%.

New image processing and noise reduction technology allows reduction of radiation exposure in complex electrophysiologic interventions while maintaining optimal image quality: a randomized clinical trial.

Background: Despite their carcinogenic potential, X-rays remain indispensable for electrophysiologic (EP) procedures.

Objective: The purpose of this study was to evaluate the dose reduction and image quality of a novel X-ray technology using advanced image processing and dose reduction technology in an EP laboratory.

Methods: In this single-center, randomized, unblinded, parallel controlled trial, consecutive patients undergoing catheter ablation for complex arrhythmias were eligible.

[Anticoagulation and atrial fibrillation].

Atrial fibrillation (AF) is the most prevalent arrhythmia in man. Incidence increases with age, risk of ischemic stroke as a result of AF disproportionally so. Anticoagulation is therefore one of the cornerstones of treatment.

Remote care: bidding our ICD patients a fond farewell?

Remote follow-up has proven its safety and efficacy in the literature, and indeed in daily use. It saves the patient time and travel, allows earlier detection of events, and reduces inappropriate shocks. At the same time, it is not infallible and definitely not a universal substitute for in-office visits, as the 5 cases below demonstrate.

Aborted sudden cardiac death in a 52-yearold man without structural heart disease.

Sudden cardiac death in the absence of apparent structural heart disease is an uncommon phenomenon. The majority of these patients do not have 'normal' hearts and specific diagnostic tools are required to identify structural or functional abnormalities. We describe the history of a 50-yearold man who survived ventricular fibrillation.

Dabigatran with or without concomitant aspirin compared with warfarin alone in patients with nonvalvular atrial fibrillation (PETRO Study).

This is the first evaluation of dabigatran, an oral direct thrombin inhibitor, in patients with atrial fibrillation (AF). Patients (n = 502) were randomized to receive blinded doses of 50-, 150-, or 300-mg dabigatran twice daily alone or combined with 81- or 325-mg aspirin or open-label warfarin administered to achieve an international normalized ratio of 2 to 3 for 12 weeks. Dabigatran plasma concentrations, activated partial thromboplastin time, D-dimer, urinary 11-dehydrothromboxane B(2) (DTB2), and liver function were measured at baseline and at 1, 2, 4, 8, and 12 weeks.

Implantable device recalls: are we throwing away the baby with the bath water?

Over the past year, there has been a sharp increase in the number of recalls, or `field safety corrective actions' concerning implantable defibrillators. This may be due to an actual rise in device or component-related problems (for which there is some evidence), overzealous reporting of potential problems (which is apparent), or most probably a combination of the two. In this day and age of increasing numbers of ICD implantations, it is essential that all concerned realise that ICDs are no more infallible than other man-made devices and that the incidence of complications is therefore likely to increase commensurately.

Early onset of coronary artery disease after prenatal exposure to the Dutch famine.

Background: Limited evidence suggests that maternal undernutrition at the time of conception is associated with increased cardiovascular disease risk in adult offspring.

Objective: We investigated whether persons conceived during the Dutch famine of World War II had an early onset of coronary artery disease (CAD).

Design: We compared the age at onset and cumulative incidence of CAD between persons born as term singletons who were exposed to the 1944-1945 Dutch famine during late (n = 160), mid- (n = 138), or early (n = 87) gestation and 590 unexposed subjects at age 50 or 58 y.

Unmasking accessory pathway conduction due to AV block following tricuspid valve replacement.

Atrioventricular block during radiofrequency (RF) ablation of an accessory pathway may be due to inadvertent RF damage or catheter pressure to the conduction system, or a pre-existent conduction defect. Conversely, block in the normal conduction system may unmask pre-excitation. We describe a case where total infra-Hisian block complicated tricuspid valve surgery, unmasking a hitherto undiagnosed left lateral accessory pathway.