Presence Of Structural Heart Disease Research Articles

Clinical Profile of the Patients with Newly Detected Left Bundle Branch Block in the Outpatient Department

Objective: The purpose of this study was to evaluate cardiac features associated with newly detected left bundle branch block (LBBB) in the outpatient department. Methods: A total of 57 patients with LBBB pattern were evaluated using electrocardiography (ECG). Patients were assessed based on their sex, age, detailed history, and cardiovascular symptoms. Cardiac investigations including ECG and echocardiography were performed. Results:The study included 30 (52.6%) males and 27 (47.5%) females, aged between 35 and 80 years. Dyspnoea (35.1%) and chest pain (22.8%) were the most common symptoms. 54.4% were hypertensive and 17.5% were diabetics. 28% had Left ventricular systolic dysfunction, and 24.5% had aortic valve disease. Left ventricular hypertrophy without any other structural heart disease was present in 28% of the patients. Only 24.5% patients presented with LBBB had a structurally normal heart in echocardiography. Myocardial performance index in echocardiography was abnormal in LBBB irrespective of the presence of structural heart disease. Conclusion: The prevalence of LBBB was found to increase with age and had slight male preponderance. Dyspnoea on effort was the most common presenting complaint, followed by chest pain and incidental detection of ECG abnormality. Most of the patients were hypertensive. Only 24.5% patients with LBBB had a structurally normal heart. MPI was abnormally high in the presence of LBBB despite having a normal left ventricular ejection fraction.

Reversal of premature ventricular complexes induced cardiomyopathy. Influence of concomitant structural heart disease

BackgroundWe examined the effect of radiofrequency (RF) catheter ablation of premature ventricular complexes (PVCs) on left ventricle (LV) function recovery in patients with LV dysfunction, regardless the presence of structural heart disease (SHD). MethodsSeventy seven patients with impaired LV ejection fraction (EF) (37.1±9.4), suspected to have PVCs cardiomyopathy (PVC-CM) (>10% PVCs burden), referred for RF ablation were enrolled, and divided into 2 groups according to the presence of SHD. SHD was ruled out by echocardiography, coronary angiography or MRI. CARTO 3 mapping system was used employing activation mapping in the majority of cases. Initial success was defined as complete elimination or residual PVCs≤10 beats/30min. Long term success was defined as reduction in PVCs burden >80% on follow-up holter. Echocardiography was done after 6 months. Improvement of EF >5% was considered significant. ResultsForty two (55.8%) cases had SHD. PVCs burden was 28.4±9.8%. EF improved to 48.6±10.3. Initial success, overall success, post procedural PVCs burden and EF were comparable in both groups. EF improved in 47(75%) of successful cases with no significant differences between both groups. Post-MI Patients were the least category to improve. PVCs burden before and after ablation were the independent predictors of LVEF recovery by multivariate analysis. Cutoff values of >18%, <8% had 100% sensitivity and 85%, 87% specificity, respectively. ConclusionsPVCs elimination by RF ablation results in significant improvement even restoration of LV function regardless of PVC origin, or the presence of concomitant SHD. PVCs burden before and after ablation are the main predictors of LVEF recovery.

Fibrilación auricular y flúter auricular

IntroductionAtrial fibrillation is the most frequent sustained arrhythmia, with a prevalence of 3% in the general population, although with a higher prevalence in the elderly, hypertensive, obese and patients with structural heart disease. DiagnosisThe electrocardiographic diagnosis is based on the identification of the irregularly irregular pattern R-R characteristic. As part of the study, it is convenient to perform a transthoracic echocardiogram, which allows us to diagnose the presence of structural heart disease and to assess the atrial size, which is important for an ablation procedure, and a complete analysis with a thyroid profile, in order to rule out Other triggers, such as anemia, infection, or hyperthyroidism. ManagementThe management of this pathology is based on three pillars: antithrombotic therapy for the prevention of systemic embolism and cerebrovascular accidents, current in recent years thanks to the appearance of oral alternatives to classical anticoagulant therapy with vitamin antagonists K; Heart rate control with braking agents, especially beta-adrenergic blockers, but also calcium-antagonists and digoxin; And rhythm control strategies, both pharmacological and percutaneous, the latter increasingly widespread due to its greater effectiveness and low incidence of complications.

Predictors and Therapy of Cardiomyopathy Caused by Frequent Ventricular Ectopy.

The aim of this review is to describe predictors and therapeutic principles for PVC-induced cardiomyopathy. PVC-induced cardiomyopathy is a treatable condition resulting in a reversible form of cardiomyopathy. PVC-induced cardiomyopathy has only recently been recognized as an entity that causes a reversible form of cardiomyopathy. The mechanism of development of PVC-induced cardiomyopathy has not yet been elucidated, although dyssynchrony appears to play a major role. Multiple factors have been described that are independently associated with PVC-induced cardiomyopathy. Predictors of PVC-induced cardiomyopathy include PVC prevalence, epicardial origin, male gender, longer symptom duration and asymptomatic status, presence of interpolated PVCs, lack of circadian variability, and a broader PVC-QRS width. In the presence of cardiomyopathy, work-up for structural heart disease and its etiology should be performed, followed by aggressive attempts at PVC reduction. There is evidence that ablation therapy is superior to medical therapy for frequent PVCs, but treatment decisions need to be individualized depending on the patients symptoms, PVC prevalence, PVC origin, patients comorbidities, and patient preference. The potential of sudden cardiac death associated with the presence of structural heart disease needs to be recognized, and appropriate risk stratification is mandatory.

Value of cardiac magnetic resonance imaging and programmed ventricular stimulation in patients with frequent premature ventricular complexes undergoing radiofrequency ablation

Frequent premature ventricular complexes (PVCs) have been associated with increased mortality. However, the optimal approach to the risk stratification of these patients is unclear. The purpose of this study was to prospectively assess the use of cardiac magnetic resonance imaging (MRI) and programmed ventricular stimulation to identify patients with PVCs undergoing radiofrequency ablation at risk for adverse long-term outcomes. A total of 321 consecutive patients (52 ± 15 years; 157 men [49%]; left ventricular ejection fraction 51% ± 12%) underwent PVC ablation between 2004 and 2015, preceded by cardiac MRI to assess for structural heart disease (SHD). Programmed stimulation was performed at the time of the ablation procedure. If ventricular tachycardia (VT) was induced in the presence of SHD, an implantable cardioverter-defibrillator (ICD) was implanted. SHD was identified by MRI in 64 patients (20%), and sustained monomorphic VT was inducible in 15 patients (5%). Fourteen patients had both SHD and inducible VT, and received an ICD after the procedure. The primary endpoint of VT/ventricular fibrillation or death was met in 15 patients after a median 20 months of follow-up. The combination of SHD by MRI and VT inducibility conferred independently an increased risk of adverse outcome (multivariate hazard ratio 25.73, 95% confidence interval 6.74-98.20; P <.001). Preablation cardiac MRI and programmed stimulation can be useful for risk stratification in patients with frequent PVCs. Patients with inducible VT in the setting of SHD may benefit from ICD implantation after ablation regardless of left ventricular ejection fraction.

Outflow tract ventricular premature beats ablation in the presence or absence of structural heart disease: Technical considerations and clinical outcomes.

BackgroundPremature ventricular beats (PVBs) are early depolarization of the myocardium originating in the ventricle. In case of very frequent PVBs, patients are severely symptomatic with impaired quality of life and are at risk of pre-syncope, syncope, heart failure, and sudden cardiac death particularly in the presence of structural heart disease. Ventricular outflow tracts are the most common sites of origin of idiopathic PVBs especially in patients without structural heart disease. We examined the role of radiofrequency catheter ablation in suppression of monomorphic PVBs of outflow tract origin in the presence or absence of structural heart disease, and its impact on improvement of left ventricular (LV) systolic function.MethodsThirty-seven highly symptomatic patients with PVBs burden exceeding 10% were enrolled, provided that PVBs are monomorphic, originating in ventricular outflow tracts and regardless the presence or absence of structural heart disease. Patients were divided into 2 groups according to PVB site origin (RVOT vs. LVOT). 3D electro-anatomical mapping modalities were used in all patients employing activation mapping technique in the majority of cases. Acute success was considered when PVBs completely disappeared or when residual sporadic PVBs ≤ 1 beats/min or ≤10 beats/30 min after RF ablation. Patients were followed up for a mean period of 5.4 ± 1.2 months with long-term success defined as complete disappearance or marked reduction by more than 75% in the PVBs absolute number on 24 h holter monitoring.ResultsMean age of the study group was 39.9 ± 12.97 years, including 22 (59.4%) males. PVBs originated in RVOT in 17 cases and in LVOT in the remaining 20 cases. Prevalence of structural heart disease and consequently shortness of breath was higher in LVOT group. Initial ECG localization matched EP localization in the majority (94%) of cases. R wave duration index was the only significant independent predictor for RVOT origin with cut off value of <0.3 (P = 0.0057) upon multivariate analysis. Acute success was encountered in 32 (86%) patients with all cases of failure in the LVOT group. Recurrence occurred in 5 (15%) cases without significant difference between both groups. All cases of recurrence had residual PVBs at the end of the procedure. 18 cases out of the study group showed significant improvement of their EF (>5%) at the end of the follow-up period with no significant differences between both groups (p = 0.09). A linear correlation was observed between PVBs burden at follow up and magnitude of improvement of LV EF, particularly in patients with resting LV dysfunction and increased LV internal dimensions.ConclusionsRF ablation is an effective and safe method for elimination of outflow tract PVBs irrespective of their origin and the presence or absence of structural heart disease. PVBs burden after ablation appears to be the main determinant for reversal of PVB induced myopathy particularly in those with increased LV internal dimensions.

Premature ventricular complexes in children with structurally normal hearts: clinical review and recommendations for diagnosis and treatment.

Premature ventricular complexes (PVCs) have always been a matter of debate among physicians and a cause for concern for family members of affected patients. The available literature on isolated PVCs in children is limited to case reports and small single-center retrospective series that are consistent in demonstrating the benign course of PVCs and their frequent disappearance during childhood, though many questions remain unanswered. Nevertheless, two key actions should be undertaken in pediatric patients with documented PVCs: 1) to rule out the presence of structural heart disease; 2) to determine whether symptoms are due to PVCs, or whether PVC frequency is responsible for left ventricular dysfunction. This document aims to provide concise and easy to understand recommendations on the diagnostic work-up of healthy children with simple PVCs and the appropriate clinical and therapeutic approach.

Clinical characteristics associated with bradycardia and asystole in patients with syncope undergoing long-term electrocardiographic monitoring with implantable loop recorder.

The aim of this retrospective single center cohort study was to assess the occurrence of bradycardia during implantable loop recorder (ILR) monitoring in patients with unexplained syncope and negative conventional testing and to identify clinical predictors of bradycardia and pacemaker implantation. An ILR was implanted in 112 patients (31men, 81women, mean age 64±13years) with syncope which was not explained after conventional diagnostic work-up. Clinical variables were compared between patients with and without pacemaker implantation. A diagnosis was made in 67patients (60%), including non-arrhythmic (vasodepressor) syncope (27patients), sinus bradycardia or asystole (23patients), atrioventricular (AV) block (14patients) and bradycardic atrial fibrillation (3patients). The mean time to diagnosis was 233± 282 days. A pacemaker was implanted in 40patients (36%). Male gender, age above 65years, hypertension, presence of structural heart disease, absence of prodromal symptoms, trauma secondary to syncope, asymptomatic sinus bradycardia and first-degree AV block were clinical predictors of pacemaker implantation in univariate analysis. Of the independent predictive factors three remained significant in multivariate analysis: absence of prodromal symptoms before the loss of consciousness (odds ratio OR3.38, p= 0.01, 95% confidence interval CI1.24-9.20), male gender (OR3.22, p= 0.01, 95% CI1.26-8.20) and age >65 years (OR2.94, p= 0.02, 95% CI1.14-8.33). In patients undergoing ILR implantation bradycardia is afrequent finding despite the negative conventional diagnostic testing. Absence of prodromal symptoms, male gender and age >65years are risk factors for bradycardia and pacemaker implantation.

The effect of radiofrequency catheter ablation of frequent premature ventricular complexes and arrhythmia burden on left ventricular function.

Frequent premature ventricular complexes (PVC) are related to reversible tachycardia-induced cardiomyopathy. However, the role of arrhythmia burden on the outcome of the catheter ablation has not been fully recognised. The aim of this study was to assess the effect of catheter ablation and PVC burden in patients with and without structural heart disease (SHD) on left ventricular ejection fraction (LVEF). Transthoracic echocardiography was done before and six months after radiofrequency catheter ablation in 109 consecutive patients (61 men, age 55 ± 17 years) with frequent PVCs. Sixty-five (59.6%) patients had underlying SHD. The catheter ablation procedure was successful in 93 (85.3%) patients. Baseline PVC burden was higher in patients with SHD (22,267 ± 12,934) compared to those without concomitant SHD (15,546 ± 7888), p = 0.005. Nevertheless, patients with LVEF ≤ 50% at baseline presented greater LVEF recovery (from 44% to 56%) than those with LVEF > 50% at baseline after catheter ablation. In both groups, the LVEF improved (p < 0.001); however, no difference was observed be-tween patients with SHD (5.7% ± 1.37%) and without (4.6% ± 0.96%) SHD; p = 0.89. PVC burden was higher in patients with (24,350 ± 2776 PVC/day) compared to those without (17,588 ± 1970 PVC/day) improvement of LVEF. In multivariate regression analysis PVC burden > 20,000/day (but not age, p = 0.95; gender, p = 0.89; presence of SHD, p = 0.53; QRS complex width of the treated PVC, p = 0.21, LVEF before ablation, p = 0.19; and site of origin, p = 47) predicted improvement in LVEF after successful catheter ablation (odds ratio: 3.53; 95% confidence interval: 1.15-10.75; p = 0.023). Catheter ablation of frequent PVCs improves left ventricular function in multivariate analysis predicted improvement of LVEF within six months after the successful catheter ablation procedure in patients with PVC burden exceeding 20,000/24 h.

Arterial Hypertension, Atrial Fibrillation, and Hyperaldosteronism: The Triple Trouble.

Atrial fibrillation (AF) involves 1% to 2% of the adult general population, a rate that increases to 15% in those 80 years and above.1 Because of the aging of the general population, this epidemic of AF is expected to increase over the next decades2–4 and to impose an increasing burden on the healthcare system because of the need for life-long care and pharmacological treatment. Identification of the mechanisms underlying AF represents an unmet need and a first step toward developing more effective preventive measures. Arterial hypertension (HT) is tightly associated with AF, as originally reported in the Framingham Heart Study5 and thereafter confirmed by several studies.6–13 HT is a major predictor of AF, and 50% to 90% of AF patients have HT. Accumulating evidences point to a role for the renin–angiotensin–aldosterone system (RAAS) in the pathophysiology of cardiac inflammation, fibrosis, and hypertrophy.14–17 Aldosterone not only exerts well-known pressor effects, but also promotes inflammation, myocardial necrosis, cardiac collagen deposition, fibrosis, and left ventricular hypertrophy (LVH).18,19 Accordingly, there is renewed interest in aldosterone as one of the major culprits leading to chamber remodeling and ultimately creating the stage for AF in hypertensive patients.15,17,20–25 The evidence supporting a role for aldosterone in AF was, however, derived from observational studies performed in patients with heart diseases that are known to cause AF. This leaves open the question of whether aldosterone triggers AF per se or only in the presence of structural heart disease. In recent years, 3 reviews examined the relation between aldosterone and AF: one focused on the antiarrhythmic potential of mineralocorticoid receptor (MR) antagonists in AF patients;26 another on the role of the MR in arrhythmias;27 and the last …

Pseudo cryomapping for ablation of atrioventricular nodal reentry tachycardia: A single center North American experience

BackgroundMost literature for cryoablation of atrioventricular nodal reentry tachycardia (AVNRT) is based on −30 degree celsius cryomapping with 4 & 6 mm distal electrode catheters. The cryomapping mode is not available on the 6 mm cryocatheter in the United States. We describe a technique for ‘pseudo’ mapping at −80° using a 6 mm cryocatheter and report on short and long term outcomes. MethodsA retrospective analysis of all index cases (n = 253) of cryoablation of AVNRT at a single North American institution during the period of 2003–2010 was performed. The majority of cases utilized a 6 mm distal electrode tip catheter. Long term follow up (2.4 ± 1.8 years) was performed via review of the medical record and by questionnaire or telephone if necessary. ResultsAcute ablation success was achieved in 93% of cases, with transient conduction defects noted in 39% of cases, and long term conduction defects in 1.6% of cases (4 patients with PR prolongation, 2 of which were permanent). General anesthesia, male gender and presence of structural heart disease were more common in the acute failure cohort. The recurrence rate for AVNRT was 8%. These patients tended to be younger and had more transient A-V conduction defects during the index procedure than those without a recurrence. ConclusionsIn conclusion, anatomic cryoablation of AVNRT utilizing a 6 mm electrode catheter with mapping performed at −80° Celsius is a safe procedure with good long term efficacy. Transient A-V block during the index procedure increases the risk of late recurrence.

Characteristics and Long-Term Outcomes of Patients with Left Ventricular Papillary Muscle Arrhythmias

Background: Ventricular arrhythmias (VAs) can originate from the left ventricular (LV) papillary muscles (PMs). In addition to causing potentially debilitating symptoms, VAs can cause significant left ventricular (LV) dysfunction. Methods: 185 patients had PVCs activation and pace mapped to the LV PMs. The clinical characteristics, aetiology and outcomes of patients were investigated. Results: At baseline, 76 (41%) had normal LVEF and 109 (59%) low LVEF (mean LVEF 30.5 ± 10.5%). PM VAs were PVCs in 123 (67%) and non-sustained VT in 61 pts (33%). Site of origin was the LV postero-medial PM in 106 (57%) and LV antero-lateral PM in 69 (37%) and both PMs in 10 pts (6%). 140 pts (76%) had idiopathic VAs and in 45 pts (24%) the site of origin of VA was confined to endocardial scar tissue. Acute success was achieved in 91% of patients. During the 65 ± 37 months of follow-up, VA free survival was 85% after a single procedure and 93% after repeat procedure. On multivariate analysis, presence of structural heart disease (HR 2.16 CI: 1.4 to 3.9 p = 006) and number of distinct PVC morphology (HR 1.5 CI: CI: 1.2 to 1.9 p = 0.02) were independent predictors of VA recurrence. After successful ablation, in pts with idiopathic VA, the mean LV ejection fraction improved from 29.7 ± 12.5% to 53.1 ± 2.5% vs. 30.5 ± 11.3% to 45.1 ± 6.5% in scar related VAs (p = 0.02). Conclusion: Catheter ablation of frequent VAs is a low-risk and effective treatment strategy.

Atrial fibrillation with high ventricular rate in emergency room: What's the best strategy for treatment?

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and can lead to significant decline in functional status and quality of life among affected patients. The risk of developing AF increases with age and the presence of structural heart disease. Thus, the attendance of patients with high ventricular response to AF is common, which makes knowledge of its management mandatory. In this context, the choice of heart rate and/or rhythm control therapy is fundamental and complex, with multiple possibilities. Thus, this review aims to assist in the management of these patients, systematizing their care.

Ventricular arrhythmias and sudden cardiac death

### Key points There are 50–100 unexpected, sudden cardiac deaths (SCDs) per 100 000 population per year in Europe and USA, categorized by symptom onset to cardiac arrest time of <1 h.1 Despite the decline in coronary artery disease mortality and advancements in resuscitation services, survival from these events remains low. Unfortunately, they often occur outside the hospital environment and are associated with a survival rate of <10%. The majority occur in adults over 35 yr of age and at least half of these events can be attributed to ventricular arrhythmias, although the true incidence is unknown due to inevitable degeneration to asystole if unwitnessed. These arrhythmias may be the presenting complaint in the emergency department and may feature throughout the perioperative period, including at preoperative assessment, during surgery and in the recovery phase, for example in intensive care. They may also be the direct target of therapy in the case of electrophysiological catheter ablation and implantable cardioverter defibrillators (ICDs). They are more frequent and carry greater risks in patients with structural heart disease, but younger patients with ion-channel abnormalities can also be susceptible.2 This review classifies the causes and significance of ventricular arrhythmias based on the presence or absence of structural heart disease and provides a simple system to aid confident distinction from supraventricular arrhythmias. …

A New Combined Parameter to Predict Premature Ventricular Complexes Induced Cardiomyopathy: Impact and Recognition of Epicardial Origin.

Reversible premature ventricular complexes-induced cardiomyopathy (PVC-CMP) is a well-described, multi-factorial entity. Single predictors, such as PVC burden or QRS duration, may not apply equally to all patients in contemporary unselected populations including patients with structural heart disease (SHD) or with particular origin such as epicardial (EPI) PVC. We sought to evaluate clinical criteria associated with PVC-CMP notably focusing on the EPI origin impact and ECG recognition and the value of a new composite predictor of PVC-CMP, the PVC-CMP-Index. We studied 107 consecutive patients (69 men; mean age = 56 ± 16 years) with frequent PVC (23.1 ± 11.5%) referred for PVC ablation. Thirty-six patients (33.6%) had an underlying SHD and 25 patients (23.4%) an EPI PVC origin. After a mean follow-up of 22.7 ± 15.3 months, 72.9% achieved a long-term successful ablation and 54.2% had PVC-CMP. PVC-CMP prevalence was significantly higher in patients with an EPI compared to endocardial PVC focus (84.0% vs. 45.1%, respectively, P < 0.001). EPI PVC origin (OR = 68.7 IC95% [3.5-1363], P = 0.005), as well as SHD (OR = 12.3 IC95% [1.6-92.6], P = 0.015), was independent predictor of PVC-CMP. While PVC burden (AUC = 0.78) or PVC-QRS width (AUC = 0.68) independently predicted PVC-CMP, the PVC-CMP-Index (values ≥39) defined as: PVC burden (0-1) × PVC-QRS width (milliseconds) × a constant C (1.28 for SHD or 2 for ECG suggesting EPI origin based on our ECG 3-step algorithm), highly correlated with PVC-CMP (AUC = 0.91, sensitivity = 93%, specificity = 80%). We developed a new index, which incorporates PVC burden, QRS width, and presence of SHD or suspected EPI origin that best predicted PVC-CMP.

Multivariate Analysis of Correspondence between Left Atrial Volumes Assessed by Echocardiography and 3-Dimensional Electroanatomic Mapping in Patients with Atrial Fibrillation.

BackgroundLeft atrial (LA) enlargement is a predictor of worse outcome after catheter ablation for atrial fibrillation (AF). Widely used two-dimensional (2D)-echocardiography is inaccurate and underestimates real LA volume (LAV). We hypothesized that baseline clinical characteristics of patients can be used to adjust 2D-ECHO indices of LAV in order to minimize this disagreement.MethodsThe study enrolled 535 patients (59 ± 9 years; 67% males; 43% paroxysmal AF) who underwent catheter ablation for AF in three specialized centers. We investigated multivariately the relationship between 2D-echocardiographic indices of LA size, specifically LA diameter in M-mode in the parasternal long-axis view (LAD), LAV assessed by the prolate-ellipsoid method (LAVEllipsoid), LAV by the planimetric method (LAVPlanimetry), and LAV derived from 3D-electroanatomic mapping (LAVCARTO).ResultsCubed LAD of 106 ± 45 ml, LAVEllipsoid of 72 ± 24 ml and LAVPlanimetry of 88 ± 30 ml correlated only modestly (r = 0.60, 0.69, and 0.53, respectively) with LAVCARTO of 137 ± 46 ml, which was significantly underestimated with a bias (±1.96 standard deviation) of -31 (-111; +49) ml, -64 (-132; +2) ml, and -49 (-125; +27) ml, respectively; p < 0.0001 for their mutual difference. LA enlargement itself, age, gender, type of AF, and the presence of structural heart disease were independent confounders of measurement error of 2D-echocardiographic LAV.ConclusionAccuracy and precision of all 2D-echocardiographic LAV indices are poor. Their agreement with true LAV can be significantly improved by multivariate adjustment to clinical characteristics of patients.

MY APPROACH to the patient with premature ventricular complexes

Frequent premature ventricular complexes (PVCs) can lead to a reversible cardiomyopathy. Frequent PVCs can also be a marker for the presence of structural heart disease. Both issues need to be addressed when a patient with frequent PVCs is evaluated. The PVC burden needs to be quantified and a predominant PVC morphology, if present, must be identified. This is best done with a 12-lead 48 h Holter monitor. Left ventricular function and dimensions need to be assessed echocardiographically. In the setting of frequent PVCs, there are three important questions that help to guide therapy:

Ocena przebiegu klinicznego i czynników wpływających na historię naturalną typowego częstoskurczu węzłowego nawrotnego

Introduction. Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common regular tachyarrhythmia; however, its clinical presentation has not been investigated in detail. The aim of the study was to assess the clinical presentation and identify the potential factors significantly affecting the natural history of AVNRT in patients undergoing RF ablation. Material and methods. Ninety-two consecutive patients with invasive diagnosis of typical AVNRT who underwent RF ablation were included. All patients were actively screened for the presence of structural heart disease (SHD). The retrospective, arrhythmia focused interviews regarding its clinical history, affecting factors and treatment were conducted. The medical records and tachycardia ECG tracings data were included, if available. Results. Seventy-five percent of patients had evidence of the arrhythmia exacerbation. No relationship between the coronary (66%) or brain (33%) hypoperfusion symptoms and clinical factors was found. Time to the tachycardia diagnosis was significantly longer in women (13 ± 11 vs 7 ± 8 years, p = 0.006). Pharmacological AVNRT management was not consistent with the ESC guidelines. The arrhythmia symptoms were occurring later if SHD was present (44 ± 13 vs 30 ± 5 years, p = 0.001). The longer AVNRT cycle length (CL), modified by the age when symptoms appeared and the presence of impaired myocardial contractility, the longer time to the arrhythmia diagnosis and exacerbation. Mitral valve prolapse (MVP) was more common in female patients compared with the general population and was found to be the factor delaying AVNRT diagnosis. Conclusions. In the majority of patients AVNRT exacerbation takes place. The coronary and brain hypoperfusion symptoms that patients often experience are nonspecific. There is a significant delay in the arrhythmia diagnosis, especially in women. SHD, AVNRT CL and MVP were identified as factors that significantly modify the arrhythmia clinical presentation.

Premature Ventricular Complex-induced Cardiomyopathy

Frequent premature ventricular complexes (PVCs) can cause an often reversible form of cardiomyopathy. The mechanism for the development of premature ventricular complex-induced cardiomyopathy (PIC) continues to be investigated, and animal models as well as human clinical trials suggest ventricular dyssynchrony to be an important component. In addition to a high PVC burden, this review will detail other risk factors associated with the development of PIC. PVCs can be a marker for the presence of other underlying disease and a thorough work-up, including cardiac magnetic resonance imaging with delayed contrast enhancement, needs to be considered to rule out the presence of structural heart disease. Management of PIC can involve catheter ablation or pharmacotherapy. Multicenter studies have shown a high success rate paired with a low complication rate with catheter ablation, and hence catheter ablation has emerged as the preferred therapeutic option for most patients with PIC. Advances in ablation strategy and technology have enhanced our ability to address certain challenging PVC locations. Important challenges that remain include understanding the coexistence of PIC with other forms of cardiomyopathy, whether there is an associated risk of sudden cardiac death, and the long-term effects on cardiac substrate of exposure to frequent PVCs.

Effect of experimental coronary sinus ligation on myocardial structure and function in the presence or absence of structural heart disease: an insight for the interventional electrophysiologist.

To study the effect of coronary sinus (CS) occlusion on normal hearts and hearts with structural disease. We included 32 dogs, divided into 4 groups: (1) CS ligation (CSL): subjected to CSL; (2) control group: no intervention; (3) MI-CSL group: subjected to myocardial infarction (MI) induction followed by CSL after 1 week; and (4) MI-control group: subjected to MI induction, then open thoracotomy after 1 week without CSL. Electrocardiography, echocardiography, histopathology, and immunohistochemistry were done before and after CSL. In CSL group, there were no significant electrocardiographic or echocardiographic changes after CSL, although there was interstitial oedema that decreased after 1 week with the appearance of Thebesian vessels and positive staining for vascular endothelial growth factor. In MI-CSL group, there was significant increase in left ventricular (LV) end-systolic diameter (P = 02), decrease in LV fractional shortening (P = 0.0001), and LV ejection fraction (P = 0.002) in comparison with MI-control group, associated with severe myocardial degeneration. Acute CS occlusion could be compensated in normal hearts, but may be detrimental in the presence of structural heart disease.