Search

[Aims] To investigate the incidence of major adverse ventricular arrhythmias and related events (MAREs) and to develop a stratification tool predicting MAREs in adults with a systemic right ventricle (sRV)., [Methods and results] In a multicentre approach, all adults (≥16 years old) with a sRV undergoing follow-up between 2000 and 2018 were identified. The incidence of MAREs, defined as sudden cardiac death, sustained ventricular tachycardia, and appropriate implantable cardioverter-defibrillator (ICD) therapy, was analysed. The association of MAREs with clinical, electrical, and echocardiographic parameters was evaluated. A total of 1184 patients (median age 27.1 years; interquartile range 19.9–34.9 years; 59% male; 70% with atrial switch repair for D-transposition of the great arteries) were included. The incidence of MAREs was 6.3 per 1000 patient-years. On multivariate analysis, age, history of heart failure, syncope, QRS duration, severe sRV dysfunction and at least moderate left ventricular outflow tract obstruction were retained in the final model with a C-index of 0.78 [95% confidence interval (CI) 0.72–0.83] and a calibration slope of 0.93 (95% CI 0.64–1.21). For every five ICDs implanted in patients with a 5-year MARE risk >10%, one patient may potentially be spared from a MARE., [Conclusion] Sudden cardiac death remains a devastating cause of death in a contemporary adult cohort with a sRV. A prediction model based on clinical, electrocardiographic, and echocardiographic parameters was devised to estimate MARE risk and to identify high-risk patients who may benefit from primary prevention ICD implantation., This work was supported by the Fédération Française de Cardiologie and the Assistance Publique des Hôpitaux de Paris.

Introduction The Ross procedure requires like the arterial switch operation (ASO) coronary artery reimplantation. There is no information on coronary artery stenosis at the site of the reimplantation in Ross patients as has been described for ASO patients. This study assessed therefore the prevalence of positive exercise tests (pETs) suggesting myocardial ischemia in Ross and ASO patients in comparison to tetralogy of Fallot patients (TOF), the latter not undergoing coronary artery reimplantation. The study evaluated further, whether a coronary artery complication was confirmed by a supplementary non- and/or invasive evaluation. Methods Results of exercise tests, echocardiography, coronary computed tomography (CCT) and coronary angiography (CA) were retrospectively reviewed in 30 Ross, 14 ASO and 30 TOF patients. Results Exercise capacity did not differ between groups. There was a trend to more frequent pETs in Ross patients (Ross vs. ASO vs. TOF, N, %): 8 (27) vs. 1 (7) vs. 2 (7) p = 0.062. CCT was performed in 30% Ross, 21% ASO, 3% TOF (p = 0.023); CA in 20% Ross, 21% ASO and 13% TOF patients (p = 0.727). None of these investigations revealed a coronary artery stenosis. Patients with pET showed a higher right ventricular outflow tract (RVOT) gradient (44 ± 30 vs. 22 ± 13 mmHg, p = 0.004) and more frequently a severe RVOT stenosis (27 vs. 0%, p Conclusions pETs are rather related to RVOT stenosis than to coronary artery complications after Ross procedure, ASO and TOF repair. The role of exercise testing for detection of myocardial ischemia is limited and should be restricted to evaluation of exercise capacity.

Accurate markers of atrial fibrillation (AF) recurrences after electrical cardioversion (ECV) are lacking. This study was conducted to assess the value of P-wave signal averaging (SAPW) for predicting AF recurrences in a nonselected patients population submitted to ECV.

BACKGROUND: Accurate markers of atrial fibrillation (AF) recurrences after electrical cardioversion (ECV) are lacking. This study was conducted to assess the value of P‐wave signal averaging (SAPW) for predicting AF recurrences in a nonselected patients population submitted to ECV. METHODS: A total of 133 patients (107 males, 26 females, mean age 66 ± 9 years) were included after successful ECV for persistent AF (mean duration of AF 3.6 ± 2.2 months). The mean ejection fraction (EF) was 60 ± 9%, and left atrial (LA) diameter was 44 ± 6 mm. SAPW ECG was obtained immediately after ECV and patients were prospectively followed. RESULTS: During a mean follow‐up of 8.9 ± 5.2 months, AF recurrences occurred in 40.6% (54/133). No SAPW parameters was statistically different between the group of patients with and the group without recurrences. Recurrences were less often observed in patients with a total P‐wave duration

Recurrences of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) are usually caused by pulmonary vein (PV) re-conduction, by foci outside the PV or by previous electrical remodelling. Substrate alterations with conduction delays may be detected by signal-averaged P-wave analysis (SAPW). This study was conducted to assess the value of the SAPW to predict recurrences after RFCA in patients with paroxysmal or persistent AF.One hundred and two patients (59 ± 10 years, 83 males) underwent a first RFCA procedure for paroxysmal (n = 61) or persistent/long-standing persistent (n = 41) AF. A SAPW recording with measurement of total filtered P-wave duration (FPD), P-wave integral, and terminal root mean squared voltage was obtained immediately after the ablation procedure and the patients were prospectively followed. During a mean follow-up of 12 ± 7 months, recurrences occurred in 36 of 102 (35.3%) patients, 17 of 61 with paroxysmal AF, and 19 of 41 with persistent AF (P = 0.06). The FPD was significantly longer in patients with recurrences compared to those without (158 ± 22 vs. 140 ± 18 ms, P = 0.0008). The FPD was shorter in patients with paroxysmal AF compared with patients with persistent AF (142 ± 28 vs. 153 ± 20 ms, P = 0.03). A FPD of 140 ms was found to discriminate patients prone to recurrences (log-rank test, P = 0.008) with a sensitivity of 69%, a specificity of 53%, a positive predictive value of 45%, and a negative predictive value of 76%.A FPD140 ms is a marker of AF recurrences after RFCA and probably reflects the extent of atrial remodelling.

A significant proportion of patients with heart failure happen to have a normal ventricular ejection fraction at echocardiography during examination. Previously called diastolic heart failure, it is nowadays referred to as heart failure with normal ejection fraction (HFNEF) or HF with preserved ejection fraction. The European Society of Cardiology, recognizing the importance of this type of heart failure, recently issued new definition criteria for it. This review will discuss the different steps that lead to such a diagnosis, as well as some new aspects of its pathophysiology. Finally, the management of this form of HF, that is not as straightforward as HF due to systolic dysfunction, will be discussed.