582 research outputs found
Anterior T-Wave Inversion Does Not Convey Short-Term Sudden Death Risk:Inverted Is the New Normal
Is there a CASTLE-AF on the hill?:Additional evidence supporting atrial fibrillation ablation in patients with symptomatic atrial fibrillation and heart failureā
Integrated care of patients with atrial fibrillation:the 2016 ESC atrial fibrillation guidelines
Catheter ablation in patients with persistent atrial fibrillation
Catheter ablation is increasingly offered to patients who suffer from symptoms due to atrial fibrillation (AF), based on a growing body of evidence illustrating its efficacy compared with antiarrhythmic drug therapy. Approximately one-third of AF ablation procedures are currently performed in patients with persistent or long-standing persistent AF. Here, we review the available information to guide catheter ablation in these more chronic forms of AF. We identify the following principles: Our clinical ability to discriminate paroxysmal and persistent AF is limited. Pulmonary vein isolation is a reasonable and effective first approach for catheter ablation of persistent AF. Other ablation strategies are being developed and need to be properly evaluated in controlled, multicentre trials. Treatment of concomitant conditions promoting recurrent AF by life style interventions and medical therapy should be a routine adjunct to catheter ablation of persistent AF. Early rhythm control therapy has a biological rationale and trials evaluating its value are underway. There is a clear need to generate more evidence for the best approach to ablation of persistent AF beyond pulmonary vein isolation in the form of adequately powered controlled multi-centre trials
Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patientsāResults from the Eurotransplant database
BackgroundPredicting complications associated with pulmonary hypertension (PH) after cardiac transplantation is an important factor when considering cardiac transplantation. The transpulmonary gradient (TPG) is recommended to quantify PH in transplant candidates. Nonetheless, PH remains a common driver of mortality. The diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) can differentiate post- from combined pre- and post-capillary PH and may improve estimation of PH-associated risks. We used a large European cohort of transplant candidates to assess whether the pulmonary pulsatility index (PAPi), improves prediction of graft failure and mortality compared to DPG and PVR.MethodsOut of all patients undergoing heart transplantation between 2009 and 2019 in Eurotransplant member states (n = 10,465), we analyzed the impact of PH (mPAP > 25 mmHg) and right heart catheter hemodynamic data on graft failure and mortality within 1ā5 years.ResultsIn 1,407 heart transplant patients with PH (79% male, median age 54 years, IQR 39ā69 years), the median PVR was 2.5 WU (IQR 1.6 WU) with a median mPAP (pulmonary arterial pressure) of 32 mmHg (IQR 9 mmHg). Patients with low (< 3 mmHg) DPG had a better 5 year survival than those with higher DPG (log rank p = 0.023). TPG, mPAP, PAPi, and PVR did not improve prediction of survival. Low PAPi (OR = 2.24, p < 0.001) and high PVR (OR = 2.12, p = 0.005) were associated with graft failure.ConclusionPAPI and PVR are associated with graft failure in patients with PH undergoing cardiac transplantation. DPG is associated with survival in this cohort
Almanac 2015: atrial fibrillation research in Heart.
Fibrilacija atrija (FA) ne prestaje biti predmet zanimanja kardiovaskularne zajednice i Äasopisa Heart. U 2014. i 2015. godini u Heartu je objavljeno viÅ”e od 60 istraživanja i preglednih Älanaka o raznim oblicima FA, od pridruženih stanja i trigerirajuÄih Äimbenika do novih pristupa lijeÄenju. Ovdje sažimamo Älanke o FA-u objavljene u Heartu tijekom 2014. i 2015. godine, uz naglasak na novim istraživanjima, idejama i pristupima lijeÄenju.Atrial fibrillation continues to attract interest in the cardiovascular community and in Heart. Over 60 original research and review papers published in Heart in 2014ā2015 cover various aspects of atrial fibrillation, from associated conditions and precipitating factors to new approaches to management. Here, we provide an overview of articles on atrial fibrillation published in Heart in 2014ā2015, highlighting new developments, emerging concepts and novel approaches to treatment
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