2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation

In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society

Association of the 894G>T polymorphism in the endothelial nitric oxide synthase gene with risk of acute myocardial infarction

Background: This study was designed to investigate the association of the 894G>T polymorphism in the eNOS gene with risk of acute myocardial infarction (AMI), extent of coronary artery disease (CAD) on coronary angiography, and in-hospital mortality after AMI. Methods: We studied 1602 consecutive patients who were enrolled in the GEMIG study. The control group was comprised by 727 individuals, who were randomly selected from the general adult population. Results: The prevalence of the Asp298 variant of eNOS was not found to be significantly and independently associated with risk of AMI (RR = 1.08, 95%CI = 0.77–1.51, P = 0.663), extent of CAD on angiography (OR = 1.18, 95%CI = 0.63–2.23, P = 0.605) and in-hospital mortality (RR = 1.08, 95%CI = 0.29–4.04, P = 0.908). Conclusion: In contrast to previous reports, homozygosity for the Asp298 variant of the 894G>T polymorphism in the eNOS gene was not found to be associated with risk of AMI, extent of CAD and in-hospital mortality after AM

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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The dilemma of providing cardioverter/defibrillator back-up for all patients with heart failure eligible for cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) achieved by biventricular pacing (CRT-P) has been proved to improve symptoms and prognosis of patients with refractory heart failure. Sudden cardiac death is quite common among patients with symptomatic heart failure and implantable cardioverter-defibrillator (ICD) therapy has been proved to effectively reduce sudden deaths in heart failure patients. Given the results of the recently published primary prevention trials and the high incidence of sudden cardiac death among CRT-P recipients, CRT combined with backup defibrillator therapy (CRT-D) seems a logical therapeutic option in patients eligible for CRT. However, the apparent beneficial effects of such an appealing combination do not alleviate the skepticism about the unselected use of CRT-D therapy. This skepticism is largely related to the high cost of this method, to the limited availability of human and financial resources and to our inability to appropriately define the selection criteria for CRT candidates, which are expected to influence the clinicians??? decisions when confronted with the dilemma of providing CRT-D therapy for all patients eligible for CRT

Classical and Non-Classical Indications for Cardiac Resynchronization Therapy

Heart failure (HF) is a medical problem of huge socioeconomic importance, mainly due to the increasing life expectancy in our societies and the strides in the treatment of ischemic heart disease which resulted in improved prognosis of our patients. These medical and socioeconomic issues may explain why HF poses a significant financial burden on our health care systems. It is estimated that acute decompensated HF accounts for 2.9% of all emergency room visits, its prevalence is steadily increasing in epidemic proportions and in age-dependent manner, reaching an incidence of almost 10% in patients aged >65 years

Percutaneous Closure of a Large Atrial Septal Defect: A Simplified Approach

A 44-year-old female patient presented with easy fatigability, dyspnea on exertion and frequent episodes of migraine. Echocardiography revealed a large atrial septal defect (ASD) of the secundum type. This was further visualized with transesophageal echocardiography (TEE) (Figure, Panel A, arrow).The diameter of the ASD at TEE was measured at 1.93 cm. Pulmonary to systematic flow ratio (Qp/Qs) was calculated at 3.3:1, indicating a significant left-to-right shunt across the ASD. Percutaneous closure of the defect was subsequently undertaken. The diameter of the defect was measured intra-procedurally using an intracardiac balloon and it was found to be 2.6 cm (Panel B).An Amplatzer 9-ASD-032 occluder was successfully implanted percutaneously via the right femoral vein (Panel C, arrow). TEE 48 hours after implantation showed that the closure device was in proper place (Panel D, arrows) and the left-to-right shunt was abolished