Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XT by three-dimensional echocardiography.

Background: Mitral valve (MV) repair with MitraClip system is a safe treatment option for high-risk patients with significant mitral regurgitation (MR). We aimed to characterize, by three-dimensional echocardiography (3D-E), changes occurring in MV after implantation of third generation MitraClip XT device, with specific reference to the underlying MR mechanism (functional vs degenerative, FMR vs DMR).

Methods: We prospectively enrolled 59 patients, who underwent intra-procedural 3D-E before and after device deployment.

Gender Differences after Transcatheter Aortic Valve Replacement (TAVR): Insights from the Italian Clinical Service Project.

Background: TAVR is a safe alternative to surgical aortic valve replacement (SAVR); however, sex-related differences are still debated. This research aimed to examine gender differences in a real-world transcatheter aortic valve replacement (TAVR) cohort.

Methods: All-comer aortic stenosis (AS) patients undergoing TAVR with a Medtronic valve across 19 Italian sites were prospectively included in the Italian Clinical Service Project (NCT01007474) between 2007 and 2019.

Non-valvular atrial fibrillation: potential clinical implications of the heterogeneous definitions used in trials on new oral anticoagulants.

Aims: To evaluate the potential impact of the different definitions of non-valvular atrial fibrillation reported in the literature and to analyse the possible implications for eligibility for novel oral anticoagulants (NOACs) in clinical practice.

Methods: We derived the definitions of 'non-valvular atrial fibrillation' from the exclusion criteria of the trials on NOACs, and then assessed the number and percentage of patients fulfilling the various definitions in a cohort of 500 consecutive atrial fibrillation patients, undergoing clinical and echocardiographic evaluation in our cardiology department, as either in-patients or out-patients.

Results: Among the 500 atrial fibrillation patients (mean age 71.

Long-term RV threshold behavior by automated measurements: safety is the standpoint of pacemaker longevity!

Background: We studied long-term right ventricular (RV) pacing threshold (RVPT) behavior in patients consecutively implanted with pacemakers capable of automatic output reprogramming tracked by automatic RV threshold measurement (automatic verification of capture [AVC]).

Methods: All the patients had state-of-the art steroid-eluting bipolar pacing leads and were RV-paced by an AVC algorithm from the three American manufacturers. Follow-up occurred twice in the first year after implantation, then yearly until approaching elective replacement indicator.

Role of drugs and devices in patients at risk of sudden cardiac death.

The search for effective treatment for preventing sudden cardiac death (SCD) initially started with anti-arrhythmic agents in high-risk patients, but the use of randomized controlled trials clearly led to the conclusion that an approach based on anti-arrhythmic agents is not useful, and sometimes potentially harmful (the risk of arrhythmic death was increased up to 159% in CAST study). Today the approach to SCD prevention includes considering both the setting of patients who have already presented a cardiac arrest or a malignant ventricular tachyarrhythmias (secondary prevention of SCD) and the much broader setting of primary prevention in patients at variable degrees of identifiable risk. For secondary prevention of SCD, implantable cardioverter defibrillation is now the standard of care (the risk of overall mortality may be reduced by 20-31%), and anti-arrhythmic agents, specifically amiodarone, have only a complementary role (for reducing device activations or for preventing atrial fibrillation).